Provider Demographics
NPI:1003562992
Name:SUCKOW, MICAH I
Entity Type:Individual
Prefix:MR
First Name:MICAH
Middle Name:
Last Name:SUCKOW
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7081 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9624
Mailing Address - Country:US
Mailing Address - Phone:716-572-6448
Mailing Address - Fax:
Practice Address - Street 1:7081 MAPLE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-9624
Practice Address - Country:US
Practice Address - Phone:716-572-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program