Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4351047683 | MI |
NPI | 1003485269 |
---|---|
Provider Name | Alex Suchorab |
First Address | Burton, MI 48509-1429 |
Second Address | Burton, MI 48509-1429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |