Healthcare Provider Details

I. General information

NPI: 1962585596
Provider Name (Legal Business Name): WEI SU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43900 GARFIELD RD STE 100
CLINTON TOWNSHIP MI
48038-1137
US

IV. Provider business mailing address

43900 GARFIELD RD STE 100
CLINTON TOWNSHIP MI
48038-1137
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-0982
  • Fax:
Mailing address:
  • Phone: 586-286-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number4301104187
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number4301104187
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number4301104187
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: