Provider Demographics
NPI:1053428201
Name:SUK, WILLIAM BEEN (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BEEN
Last Name:SUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 KENNERLY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2106
Mailing Address - Country:US
Mailing Address - Phone:314-525-1900
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009030852207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116040 7Medicaid
ILP00350429OtherRAILROAD MEDICARE
IL08232204OtherBLUE CROSS BLUE SHIELD
IL036116040Medicaid
IL06032182OtherBLUE CROSS BLUE SHIELD
IL08232205OtherBLUE CROSS BLUE SHIELD
IL08232205OtherBLUE CROSS BLUE SHIELD
IL036116040Medicaid
ILK31391Medicare PIN
BS8825715OtherDEA CERTIFICATE
ILP00350429OtherRAILROAD MEDICARE
IL08232204OtherBLUE CROSS BLUE SHIELD