Healthcare Provider Details

I. General information

NPI: 1407939697
Provider Name (Legal Business Name): RON WILLIAM SUTTON C.O CERTIFIED ORTHO.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RON W SUTTON ORTHOTIST CERT.

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOODLAND PASS SUITE E
EAST LANSING MI
48823-2000
US

IV. Provider business mailing address

PO BOX 80
GREGORY MI
48137-0080
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-0303
  • Fax: 734-498-3133
Mailing address:
  • Phone: 517-333-0304
  • Fax: 734-498-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number0-1338
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: