Provider Demographics
NPI:1790774131
Name:SUTKOWI TOOMAJIAN, LYNETTE M (DO)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
Last Name:SUTKOWI TOOMAJIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:MARIA
Other - Last Name:SUTKOWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13355 E 10 MILE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2048
Mailing Address - Country:US
Mailing Address - Phone:586-756-7090
Mailing Address - Fax:586-756-7091
Practice Address - Street 1:13355 E 10 MILE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:586-756-7090
Practice Address - Fax:586-756-7091
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012826207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4343595-11Medicaid
MIM18910009Medicare ID - Type Unspecified
MI4343595-11Medicaid