Provider Demographics
NPI:1508946385
Name:SULICH, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SULICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29200 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1274
Mailing Address - Country:US
Mailing Address - Phone:586-777-7577
Mailing Address - Fax:586-777-6841
Practice Address - Street 1:29200 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1274
Practice Address - Country:US
Practice Address - Phone:586-777-7577
Practice Address - Fax:586-777-6841
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAS048976207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2594326Medicaid
MI383022841OtherCOMML INS
MI0E06260Medicare ID - Type Unspecified
MI2594326Medicaid