Provider Demographics
NPI:1497753263
Name:SUKHON, NASSER (MD)
Entity Type:Individual
Prefix:
First Name:NASSER
Middle Name:
Last Name:SUKHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 PLYMOUTH RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3208
Mailing Address - Country:US
Mailing Address - Phone:734-761-2900
Mailing Address - Fax:734-761-5823
Practice Address - Street 1:3055 PLYMOUTH RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3208
Practice Address - Country:US
Practice Address - Phone:734-761-2900
Practice Address - Fax:734-761-5283
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4787967Medicaid
MI4787967Medicaid