Sutter Gould Medical Foundation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUTTER GOULD MEDICAL FOUNDATION

Doing business as

Kettleman Care Center

Practice address

1335 S Fairmont Ave
Lodi, CA 95240-5520

Phone

(209) 366-2007

NPI assigned

Jun 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steven A Mitnick, MD

Title

Medical Director

Phone

(209) 521-6097

Specialties & licenses 1

Addresses

Other names 1

• Kettleman Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273104000000",
    "number": "1982648580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405520",
            "telephone_number": "209-366-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER GOULD MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2010-05-06",
        "status": "A",
        "authorized_official_last_name": "MITNICK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "209-521-6097",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kettleman Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sam Nazih Suliman, D.D.S, MDS
• Marietta Abellera Sumaquial, M.D.
• Justin Jay Sunseri, LMFT
• Sutter Gould Medical Foundation
• Sutter Gould Medical Foundation
• Sutter Valley Medical Foundation
• Robert Eugene Sutter, D.D.S.,M.S.
• Diane C. Sutton, LAC
• Mitchell R Swanson, D.C.
• Chris R. Swartwood, PT

• Family Medicine Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.