1083726681 NPI number — RICHARD W SUTTLE P.A.

Table of content: RICHARD W SUTTLE P.A. (NPI 1083726681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083726681 NPI number — RICHARD W SUTTLE P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTTLE
Provider First Name:
RICHARD
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083726681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7520 SUSSEX DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48187-2238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-927-0009
Provider Business Mailing Address Fax Number:
734-927-0009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 S ADAMS RD
Provider Second Line Business Practice Location Address:
#243
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-220-1148
Provider Business Practice Location Address Fax Number:
248-220-1151
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  5601001147 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5601001147 . This is a "P.A.. LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700H231390 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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