Healthcare Provider Details

I. General information

NPI: 1770178642
Provider Name (Legal Business Name): BRET CHRISTOPHER SUTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 15 MILE RD
STERLING HEIGHTS MI
48312-4511
US

IV. Provider business mailing address

1740 LAKEWOOD DR
TROY MI
48083-5553
US

V. Phone/Fax

Practice location:
  • Phone: 586-783-8113
  • Fax:
Mailing address:
  • Phone: 248-930-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: