Provider Demographics
NPI:1790193324
Name:SUBURBAN HEALTHCARE ORGANIZATION PLLC
Entity Type:Organization
Organization Name:SUBURBAN HEALTHCARE ORGANIZATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:LUTWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-752-6281
Mailing Address - Street 1:1600 KINGSWAY CT
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1962
Mailing Address - Country:US
Mailing Address - Phone:734-752-6281
Mailing Address - Fax:734-752-6559
Practice Address - Street 1:1600 KINGSWAY CT
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1962
Practice Address - Country:US
Practice Address - Phone:734-752-6281
Practice Address - Fax:734-752-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013979244OtherBCBS