Provider Demographics
NPI:1669735700
Name:SUTKO, ALYCE (MD/MPH)
Entity type:Individual
Prefix:
First Name:ALYCE
Middle Name:
Last Name:SUTKO
Suffix:
Gender:F
Credentials:MD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NE THORNTON PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8021
Mailing Address - Country:US
Mailing Address - Phone:206-520-2434
Mailing Address - Fax:
Practice Address - Street 1:331 NE THORNTON PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8021
Practice Address - Country:US
Practice Address - Phone:206-520-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60288833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAML60288833OtherWA STATE LICENSE NUMBER