Healthcare Provider Details

I. General information

NPI: 1932552742
Provider Name (Legal Business Name): CHRISTINE OMILION-SUGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2016
Last Update Date: 07/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 MITCHELL PARK DR SUITE 10
PETOSKEY MI
49770-8674
US

IV. Provider business mailing address

2206 MITCHELL PARK DR SUITE 10
PETOSKEY MI
49770-8674
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-6076
  • Fax: 231-487-6569
Mailing address:
  • Phone: 231-487-6076
  • Fax: 231-487-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401015487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: