Provider Demographics
NPI:1104029693
Name:SUGG, KRISTOFFER BRADLEY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:BRADLEY
Last Name:SUGG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5308 HARROUN RD STE 280
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2190
Practice Address - Country:US
Practice Address - Phone:567-585-2080
Practice Address - Fax:567-585-2081
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010903232086S0122X
OH35.1463202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery