Provider Demographics
NPI:1659453256
Name:MICHAEL S SUTRO MD INC
Entity Type:Organization
Organization Name:MICHAEL S SUTRO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUTRO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:415-600-7840
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:518
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-600-7840
Mailing Address - Fax:415-600-7845
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:518
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-600-7840
Practice Address - Fax:415-600-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35951207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G359510Medicare PIN