Provider Demographics
NPI:1871759720
Name:GEOFFREY E SULTANA MD PLLC
Entity type:Organization
Organization Name:GEOFFREY E SULTANA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-536-0897
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-2078
Mailing Address - Country:US
Mailing Address - Phone:253-293-5453
Mailing Address - Fax:866-581-5147
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:400
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-293-5453
Practice Address - Fax:866-581-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8875087Medicare PIN