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NPI Code Detail

MEDICARE: SUHAN A IDRISS

MEDICARE: SUHAN A IDRISS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1063233351
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUHAN A IDRISS
Provider Business Mailing Address
First Line : 1122 WALNUT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-3937
Country : US
Telephone Number : 734-252-5215
Fax Number : 734-822-0237
Provider Business Practice Location Address
First Line : 1122 WALNUT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-3937
Country : US
Telephone Number : 734-252-5215
Fax Number : 734-822-0237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2024
Last Update Date : 10/21/2024

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Directions to “ SUHAN A IDRISS ” Practice Location

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