Healthcare Provider Details

I. General information

NPI: 1427128925
Provider Name (Legal Business Name): SUSAN LITTLE JONES MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARCLAY CIR SUITE 120
ROCHESTER HILLS MI
48307-5820
US

IV. Provider business mailing address

75 BARCLAY CIR SUITE 120
ROCHESTER HILLS MI
48307-5820
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-0315
  • Fax: 248-844-0320
Mailing address:
  • Phone: 248-844-0315
  • Fax: 248-844-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberSL073954
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSL073954
License Number StateMI

VIII. Authorized Official

Name: MS. MARGARET A HUNKELE
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-844-9742