Provider Demographics
NPI:1841339868
Name:DELEA, SUZANNE L (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:DELEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5025
Mailing Address - Country:US
Mailing Address - Phone:623-566-3550
Mailing Address - Fax:623-566-3573
Practice Address - Street 1:6818 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5025
Practice Address - Country:US
Practice Address - Phone:623-566-3550
Practice Address - Fax:623-566-3573
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2006-0238207R00000X
ORMD154339207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500635277Medicaid
ORP00965912OtherRR MEDICARE - PHS
ORP00965912OtherRR MEDICARE - PHS