Provider Demographics
NPI:1780852053
Name:ELIZABETH L. SUH, M.D. PLLC
Entity Type:Organization
Organization Name:ELIZABETH L. SUH, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-721-9999
Mailing Address - Street 1:2835 FORT MISSOULA RD STE 305
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7424
Mailing Address - Country:US
Mailing Address - Phone:406-721-9999
Mailing Address - Fax:406-721-9756
Practice Address - Street 1:2835 FORT MISSOULA RD STE 305
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7424
Practice Address - Country:US
Practice Address - Phone:406-721-9999
Practice Address - Fax:406-721-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10065208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1548323835OtherNPI #
MT0153578Medicaid
MTP00304453OtherMEDICARE RAILROAD
MTP00304453OtherMEDICARE RAILROAD