Healthcare Provider Details

I. General information

NPI: 1063506335
Provider Name (Legal Business Name): SUSUMU INOUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ 3A-WB
FLINT MI
48503-5902
US

IV. Provider business mailing address

1 HURLEY PLZ SON, 5TH FLOOR
FLINT MI
48503-5902
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-7303
  • Fax: 810-257-9736
Mailing address:
  • Phone: 810-262-9353
  • Fax: 810-760-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301032759
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: