Provider Demographics
NPI:1396829818
Name:SULTENFUSS, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:SULTENFUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HARBOR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2605
Mailing Address - Country:US
Mailing Address - Phone:727-385-9052
Mailing Address - Fax:
Practice Address - Street 1:102 HARBOR VIEW LN
Practice Address - Street 2:
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-2605
Practice Address - Country:US
Practice Address - Phone:727-385-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1000091OtherUNITED HEALTHCARE
FL62317OtherBLUE CROSS/BLUE SHIELD
FLCL2114OtherPALMETTO GBA MEDICARE RR
FL0965599OtherAETNA
FL4235833OtherAETNA
FLD77530Medicare UPIN
FL1000091OtherUNITED HEALTHCARE