Healthcare Provider Details

I. General information

NPI: 1588868699
Provider Name (Legal Business Name): SUKI WELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OAK ST
BIG RAPIDS MI
49307-2048
US

IV. Provider business mailing address

4100 EMBASSY DR SE
GRAND RAPIDS MI
49546-2416
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-8691
  • Fax:
Mailing address:
  • Phone: 616-988-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301506095
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM9736
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.090352
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: