Healthcare Provider Details

I. General information

NPI: 1407272206
Provider Name (Legal Business Name): SUMA THOMAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD STE 202
LANSING MI
48912-3757
US

IV. Provider business mailing address

1540 LAKE LANSING RD STE 202
LANSING MI
48912-3757
US

V. Phone/Fax

Practice location:
  • Phone: 517-913-3820
  • Fax: 517-913-3821
Mailing address:
  • Phone: 517-913-3820
  • Fax: 517-913-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101022941
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: