Provider Demographics
NPI:1942463252
Name:SUTHERLAND, LILIYA SHEVCHENKO (DO)
Entity Type:Individual
Prefix:DR
First Name:LILIYA
Middle Name:SHEVCHENKO
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LILIYA
Other - Middle Name:
Other - Last Name:SHEVCHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5030 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3725
Mailing Address - Country:US
Mailing Address - Phone:616-954-2020
Mailing Address - Fax:616-949-0408
Practice Address - Street 1:5030 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3725
Practice Address - Country:US
Practice Address - Phone:616-954-2020
Practice Address - Fax:616-949-0408
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017636207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology