Provider Demographics
NPI:1407939697
Name:SUTTON, RON WILLIAM (CO CERTIFIED ORTHO)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:WILLIAM
Last Name:SUTTON
Suffix:
Gender:M
Credentials:CO CERTIFIED ORTHO
Other - Prefix:MR
Other - First Name:RON
Other - Middle Name:W
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ORTHOTIST CERT
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:MI
Mailing Address - Zip Code:48137-0080
Mailing Address - Country:US
Mailing Address - Phone:517-333-0304
Mailing Address - Fax:734-498-3133
Practice Address - Street 1:200 WOODLAND PASS
Practice Address - Street 2:SUITE E
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2000
Practice Address - Country:US
Practice Address - Phone:517-333-0303
Practice Address - Fax:734-498-3133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0-1338247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2913580Medicaid
OH0944321Medicaid
MI0412230001Medicare NSC