Provider Demographics
NPI:1518019397
Name:SULISZ, CHERYL ANN (MD, MPH, MS, FACOEM)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:SULISZ
Suffix:
Gender:F
Credentials:MD, MPH, MS, FACOEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 METRO AIRPORT CENTER DR.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-955-7000
Mailing Address - Fax:734-955-7006
Practice Address - Street 1:11700 METRO AIRPORT CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1404
Practice Address - Country:US
Practice Address - Phone:734-955-7000
Practice Address - Fax:734-955-7006
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010514862083X0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1504Medicare PIN
MIMI1503019Medicare UPIN
MIMI1504019Medicare UPIN
MIMI1503Medicare PIN