Healthcare Provider Details

I. General information

NPI: 1528398195
Provider Name (Legal Business Name): ELENA SUTU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE SUITE 460
LANSING MI
48912-1800
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5490
  • Fax: 517-364-5499
Mailing address:
  • Phone: 517-364-5490
  • Fax: 517-364-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number4301087436
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: