Healthcare Provider Details

I. General information

NPI: 1770787178
Provider Name (Legal Business Name): RACHEL F SUSSMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PARK ST SUITE 201
BIRMINGHAM MI
48009-3400
US

IV. Provider business mailing address

36500 FORD RD STE 212
WESTLAND MI
48185-3769
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-8346
  • Fax: 586-279-2124
Mailing address:
  • Phone: 586-997-0999
  • Fax: 586-997-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number5101015250
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101015250
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: