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General NPI Number Information
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NPI Number | 1780577999
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Entity Type | Organization
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Legal Business Name | SUMMIT DERMATOLOGY PLLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 14700 FARMINGTON RD STE 105
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City | LIVONIA
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State | MI
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Zip | 48154-5434
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Country | US
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Telephone | 734-361-2191
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Fax | 734-361-9701
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Provider Business Mailing Address
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Address Line | 14700 FARMINGTON RD STE 105
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City | LIVONIA
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State | MI
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Zip | 48154-5434
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Country | US
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Telephone | 734-361-2191
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Fax | 734-361-9701
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SULTAN QIBLAWI
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Credential | MD, MBA
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Telephone | 586-530-6365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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