Healthcare Provider Details

I. General information

NPI: 1558154625
Provider Name (Legal Business Name): SUFYAN FOOT AND ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 1012
DETROIT MI
48201-2021
US

IV. Provider business mailing address

4160 JOHN R ST STE 1012
DETROIT MI
48201-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-6442
  • Fax: 313-831-6513
Mailing address:
  • Phone: 313-831-6442
  • Fax: 313-831-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YASSER SUFYAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 313-333-0564