MEDICARE: DR. SUEZETTE OLAKER M.D.

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	2083X0100X	Occupational Medicine Physician	4301060261	MI
2	208VP0000X	Pain Medicine Physician	4301060261	MI
3	207Q00000X	Family Medicine Physician	4301060261	MI

General Provider Information

NPI Number	:	1437374030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUEZETTE OLAKER M.D.

Provider Business Mailing Address
First Line	:	2711 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4105
Country	:	US
Telephone Number	:	313-637-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4105
Country	:	US
Telephone Number	:	313-637-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	01/31/2023

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