Provider Demographics
NPI:1093222044
Name:SUTHERLAND, BRAD (NP)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34301 23 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4432
Mailing Address - Country:US
Mailing Address - Phone:586-725-1770
Mailing Address - Fax:586-725-4080
Practice Address - Street 1:34301 23 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4432
Practice Address - Country:US
Practice Address - Phone:586-725-1770
Practice Address - Fax:586-725-4080
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704264863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily