Provider Demographics
NPI:1558521468
Name:MICHAEL J. SUTHERLAND, MD, PA
Entity Type:Organization
Organization Name:MICHAEL J. SUTHERLAND, MD, PA
Other - Org Name:PINE BLUFF SURGICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-535-2716
Mailing Address - Street 1:1801 W 40TH AVE STE 7B
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6964
Mailing Address - Country:US
Mailing Address - Phone:870-535-2716
Mailing Address - Fax:870-535-0527
Practice Address - Street 1:1801 W 40TH AVE STE 7B
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6964
Practice Address - Country:US
Practice Address - Phone:870-535-2716
Practice Address - Fax:870-535-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5356208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty