Healthcare Provider Details

I. General information

NPI: 1447602271
Provider Name (Legal Business Name): IMAN SULEIMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. EAST AVENUE 2ND FL CAB
JACKSON MI
49201
US

IV. Provider business mailing address

205 N. EAST AVENUE 2ND FL CAB
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-3964
  • Fax: 517-205-7050
Mailing address:
  • Phone: 517-205-3964
  • Fax: 517-205-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number319015-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number319015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: