Healthcare Provider Details

I. General information

NPI: 1790773729
Provider Name (Legal Business Name): SUMAN PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S NEWBURGH RD
WAYNE MI
48184-1001
US

IV. Provider business mailing address

2901 S NEWBURGH RD
WAYNE MI
48184-1001
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-7220
  • Fax: 734-729-7227
Mailing address:
  • Phone: 734-729-7220
  • Fax: 734-729-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP406326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: