Provider Demographics
NPI:1851492318
Name:SUL, YI CHUL (MD)
Entity Type:Individual
Prefix:
First Name:YI
Middle Name:CHUL
Last Name:SUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25195 KELLY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4909
Mailing Address - Country:US
Mailing Address - Phone:586-777-3370
Mailing Address - Fax:586-777-3380
Practice Address - Street 1:25195 KELLY RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4909
Practice Address - Country:US
Practice Address - Phone:586-777-3370
Practice Address - Fax:586-777-3380
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010397802084N0400X
CAC508702084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1395373Medicaid
MIN50380002Medicare PIN
A77289Medicare UPIN