Healthcare Provider Details

I. General information

NPI: 1639309131
Provider Name (Legal Business Name): WILLIAM SULAKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 W MAPLE RD SUITE 140
WEST BLOOMFIELD MI
48322-2267
US

IV. Provider business mailing address

PO BOX 673135
DETROIT MI
48267-3135
US

V. Phone/Fax

Practice location:
  • Phone: 248-406-1000
  • Fax: 248-406-1001
Mailing address:
  • Phone: 734-464-8300
  • Fax: 734-464-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301095182
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: