Provider Demographics
NPI:1407844681
Name:SUJKA, STAN K (MD)
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:K
Last Name:SUJKA
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 1:41 W KALEY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2942
Mailing Address - Country:US
Mailing Address - Phone:407-843-6645
Mailing Address - Fax:407-843-4519
Practice Address - Street 1:41 W KALEY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2942
Practice Address - Country:US
Practice Address - Phone:407-843-6645
Practice Address - Fax:407-843-4519
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51657208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037537300Medicaid
FL07919YMedicare ID - Type Unspecified
FL037537300Medicaid