Provider Demographics
NPI:1558015750
Name:SUTER MICHIGAN PLLC
Entity Type:Organization
Organization Name:SUTER MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGGELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-988-4504
Mailing Address - Street 1:5555 N LAMAR BLVD
Mailing Address - Street 2:STE H125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1096
Mailing Address - Country:US
Mailing Address - Phone:866-988-4504
Mailing Address - Fax:
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:STE H125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1096
Practice Address - Country:US
Practice Address - Phone:866-988-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental