Provider Demographics
NPI:1982050209
Name:SHETH, SUCHIR KETAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUCHIR
Middle Name:KETAN
Last Name:SHETH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 465W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2178
Mailing Address - Country:US
Mailing Address - Phone:717-250-9383
Mailing Address - Fax:281-901-1601
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 465W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2178
Practice Address - Country:US
Practice Address - Phone:717-250-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5904213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery