MEDICARE: DR. JON F SULESKEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	5101011241	MI
2	208800000X	Urology Physician	12472A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841255585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON F SULESKEY D.O.

Provider Business Mailing Address
First Line	:	6522 FAITH DR
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-2759
Country	:	US
Telephone Number	:	248-765-0529
Fax Number	:

Provider Business Practice Location Address
First Line	:	3512 PRIMROSE DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5268
Country	:	US
Telephone Number	:	248-852-4030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	10/19/2023

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