Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301090323 | MI |
NPI | 1104029693 |
---|---|
Provider Name | Kristoffer Bradley Sugg |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Brighton, MI 48114-7004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 09/03/2020 |