Provider Demographics
NPI:1740240563
Name:EUGENE Y. SU, M.D., P.C.
Entity Type:Organization
Organization Name:EUGENE Y. SU, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-572-9090
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:R4108
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-572-9090
Mailing Address - Fax:734-570-9100
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:R4108
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-572-9090
Practice Address - Fax:734-570-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIES043697207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1561438Medicaid
MI08101578111Medicare ID - Type Unspecified
MI1561438Medicaid