Provider Demographics
NPI:1982675724
Name:SUCHART, SOOD (MD)
Entity Type:Individual
Prefix:
First Name:SOOD
Middle Name:
Last Name:SUCHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 N 19TH AVE
Mailing Address - Street 2:STE 311
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015
Mailing Address - Country:US
Mailing Address - Phone:602-242-4804
Mailing Address - Fax:602-242-9635
Practice Address - Street 1:6036 N 19TH AVE
Practice Address - Street 2:STE 311
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-242-4804
Practice Address - Fax:602-242-9635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27548222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0041911OtherAHCCCS
AZ0050080OtherBCBS
D00386Medicare UPIN