MEDICARE: SUHA KASSAB DPM PC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5287600001	OTHER	MI	DME PTAN NUMBER

General Provider Information

NPI Number	:	1316767403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUHA KASSAB DPM PC

Provider Business Mailing Address
First Line	:	10 W SQUARE LAKE RD STE 300
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0468
Country	:	US
Telephone Number	:	248-333-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 W SQUARE LAKE RD STE 300
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0468
Country	:	US
Telephone Number	:	248-333-4900
Fax Number	:	248-333-4905

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	CATHY CABANAW
Credential	:
Telephone Number	:	248-333-4900

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/21/2024

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Directions to “SUHA KASSAB DPM PC ” Practice Location

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