Provider Demographics
NPI:1275637449
Name:SUHANIC, KIMBERLEY ANN (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:SUHANIC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W 17530 CO RD H42
Mailing Address - Street 2:
Mailing Address - City:CURTIS
Mailing Address - State:MI
Mailing Address - Zip Code:49820
Mailing Address - Country:US
Mailing Address - Phone:906-586-3300
Mailing Address - Fax:
Practice Address - Street 1:301 EXPLORER ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-2813
Practice Address - Country:US
Practice Address - Phone:906-346-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2750609Medicaid
MI700D81000OtherBLUE CROSS BLUE SHIELD MI
MIF00571Medicare UPIN
MI0M22930001Medicare ID - Type Unspecified