Provider Demographics
NPI:1548245806
Name:SUE, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SUE
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 1:102 NORTHSIDE PARK
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9337
Mailing Address - Country:US
Mailing Address - Phone:252-335-4619
Mailing Address - Fax:252-335-5744
Practice Address - Street 1:102 NORTHSIDE PARK
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9337
Practice Address - Country:US
Practice Address - Phone:252-335-4619
Practice Address - Fax:252-335-5744
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600169173000000X
NC151718174400000X
VA0101048956207R00000X, 207RG0100X
DEC1-0012813207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100008745OtherRAILROAD MEDICARE
NC561976984OtherTAX-ID
NC2954451OtherUNITED HEALTHCARE
NC559662OtherALLIANE PPO
NC80781OtherBCBS OF NORTH CAROLINA
NC89807081Medicaid
NC100008745OtherRAILROAD MEDICARE
NC89807081Medicaid