Healthcare Provider Details

I. General information

NPI: 1619149010
Provider Name (Legal Business Name): SUHA KASSAB DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W SQUARE LAKE RD STE300
BLOOMFIELD HILLS MI
48302-0465
US

IV. Provider business mailing address

10 W SQUARE LAKE RD STE 300
BLOOMFIELD HILLS MI
48302-0465
US

V. Phone/Fax

Practice location:
  • Phone: 248-333-4900
  • Fax: 248-333-4905
Mailing address:
  • Phone: 248-333-4900
  • Fax: 248-333-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSK001415
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SUHA KASSAB
Title or Position: PRESIDENT
Credential: DPM
Phone: 248-333-4900