Provider Demographics
NPI:1629281472
Name:THOMAS J SULTENFUSS MD PA
Entity Type:Organization
Organization Name:THOMAS J SULTENFUSS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOESPH
Authorized Official - Last Name:SULTENFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-734-6710
Mailing Address - Street 1:1022 MAIN ST STE R
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5225
Mailing Address - Country:US
Mailing Address - Phone:727-734-6710
Mailing Address - Fax:727-734-6712
Practice Address - Street 1:1022 MAIN ST STE R
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5225
Practice Address - Country:US
Practice Address - Phone:727-734-6710
Practice Address - Fax:727-734-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34798207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0965599OtherAETNA
FL4235833OtherAETNA
FL1000091OtherUNITED HEALTHCARE
FL62317OtherBLUE SHIELD
FLCL2114OtherPALMETTO GBA MEDICARE RR
FLCL2114OtherPALMETTO GBA MEDICARE RR
FL=========OtherMULTIPLAN
FL=========OtherAMERICAN MEDICAL SECURITY
FL=========OtherHUMANA MEDICARE HMO PLANS
FL0965599OtherAETNA
FL=========OtherFIRST HEALTH
FL62317OtherBLUE SHIELD
FL=========OtherAMERICAN MEDICAL SECURITY