Provider Demographics
NPI:1730543117
Name:SULPIZIO, EMILIO DENICIO (MD)
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:DENICIO
Last Name:SULPIZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W 5TH AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2967
Mailing Address - Country:US
Mailing Address - Phone:509-755-5800
Mailing Address - Fax:
Practice Address - Street 1:910 W 5TH AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2967
Practice Address - Country:US
Practice Address - Phone:509-755-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD191745207R00000X
CAA162146207RH0003X, 208M00000X
390200000X
WAMD61271235207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program