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General NPI Number Information
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NPI Number | 1083726681
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Entity Type | Individual
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Provider Name | RICHARD W SUTTLE P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 725 S ADAMS RD #243
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6902
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Country | US
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Telephone | 248-220-1148
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Fax | 248-220-1151
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Provider Business Mailing Address
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Address Line | 7520 SUSSEX DR
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City | CANTON
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State | MI
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Zip | 48187-2238
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Country | US
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Telephone | 734-927-0009
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Fax | 734-927-0009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601001147
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License Number State | MI
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