Provider Demographics
NPI:1700869617
Name:SULEK, RICHARD LEO (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEO
Last Name:SULEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2302
Mailing Address - Country:US
Mailing Address - Phone:740-592-9374
Mailing Address - Fax:740-592-9396
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2302
Practice Address - Country:US
Practice Address - Phone:740-592-9374
Practice Address - Fax:740-592-9396
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004840S2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0935742Medicaid
OH0935742Medicaid
OH4303591Medicare PIN
OH0747029Medicare PIN
F12512Medicare UPIN
OH0747028Medicare PIN