Provider Demographics
NPI:1396847802
Name:SULEIMAN, WILLIAM MARCO A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARCO A
Last Name:SULEIMAN
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:PO BOX 2258
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-2258
Mailing Address - Country:US
Mailing Address - Phone:308-865-7474
Mailing Address - Fax:308-865-2935
Practice Address - Street 1:10 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2926
Practice Address - Country:US
Practice Address - Phone:308-865-7474
Practice Address - Fax:308-865-2935
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18515208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02619OtherBLUE CROSS BLUE SHIELD
SD7775742Medicaid
SD7775742Medicaid
090384Medicare ID - Type Unspecified