Provider Demographics
NPI:1972774131
Name:VICTOR R SUCHESKI DPM
Entity Type:Organization
Organization Name:VICTOR R SUCHESKI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUCHESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-626-5062
Mailing Address - Street 1:1110 CORKER STREET
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-626-5062
Mailing Address - Fax:530-626-4130
Practice Address - Street 1:1110 CORKER STREET
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-626-5062
Practice Address - Fax:530-626-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE27030213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00245457OtherRAILROAD MEDICARE
CA000E27031Medicare PIN
CAP00245457OtherRAILROAD MEDICARE
CA4059630001Medicare NSC