Provider Demographics
NPI:1629176896
Name:STEVEN W SUKIN MD PA
Entity Type:Organization
Organization Name:STEVEN W SUKIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SUKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-813-0432
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:STE 14
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4593
Mailing Address - Country:US
Mailing Address - Phone:281-255-9229
Mailing Address - Fax:
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:STE 14
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4593
Practice Address - Country:US
Practice Address - Phone:281-255-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0085QFOtherBCBS
516948372OtherTRICARE
516948372OtherTRICARE