Basic Information
| Provider Information | |||||||||
| NPI: | 1033104062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUECOF | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3165 MCCRORY PL STE 174 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328033727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072195402 | ||||||||
| FaxNumber: | 4075171040 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 N PARK AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074101234 | ||||||||
| FaxNumber: | 4075171040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 05/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 000281 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213EP1101X | 000281 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ER0200X | 000281 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | 213ES0103X | 000281 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | POOOO2293 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 06-1406459 | 01 | CT | CORVEL | OTHER | 06-1406459 | 01 | CT | HMC, PPO | OTHER | 06-1406459 | 01 | CT | FOCUS | OTHER | 06-1406459 | 01 | CT | GREAT WEST HEALTHCARE | OTHER | 06-1406459 | 01 | CT | UNITED HEALTHCARE | OTHER | 06-1406459 | 01 | CT | PRIVATE HEALTHCARE SYSTEM | OTHER | 2534362 | 01 | CT | AETNA | OTHER | 004006805 | 05 | CT | MEDICAID | 06-1406459 | 01 | CT | COLONIAL COOPERATIVE CARE | OTHER | 060021 | 01 | CT | CONNECTICARE | OTHER | 0600211278 | 01 | CT | CONNECTICARE | OTHER | 480000668 | 01 | MEDICARE | OTHER | 0R3020 | 01 | CT | HEALTH NET | OTHER | 1033104062 | 01 | CT | ANTHEM BCBS | OTHER | 0358436 | 05 | MA | MEDICAID | 06-1406459 | 01 | CT | MULTIPLAN | OTHER | 06-1406459 | 01 | CT | NORTHEAST HEALTH DIRECT | OTHER | 0724234 001 | 01 | CT | CIGNA | OTHER | P4041219 | 01 | CT | OXFORD | OTHER |