Provider Demographics
NPI:1891233219
Name:SUZ M.D. LLC
Entity Type:Organization
Organization Name:SUZ M.D. LLC
Other - Org Name:TERRACE LANDING FINEST MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-838-1369
Mailing Address - Street 1:11808 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1536
Mailing Address - Country:US
Mailing Address - Phone:813-838-1369
Mailing Address - Fax:
Practice Address - Street 1:11946 SKYLAKE PL
Practice Address - Street 2:UNIT D
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1623
Practice Address - Country:US
Practice Address - Phone:813-838-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651458Medicaid
FLME119290OtherLICENSE
FLP01430305OtherR&R MEDICARE