Provider Demographics
NPI:1730122326
Name:SU, EUGENE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:Y
Last Name:SU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 4108
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-5678
Mailing Address - Fax:734-712-5677
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 4108
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1001
Practice Address - Country:US
Practice Address - Phone:734-712-5678
Practice Address - Fax:734-712-5677
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2015-07-16
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Provider Licenses
StateLicense IDTaxonomies
MI207RR0500X207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1561438Medicaid
MI1561438Medicaid
MIA78193Medicare UPIN