Provider Demographics
NPI:1013960384
Name:SUKARI, AMMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:
Last Name:SUKARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:800-527-6266
Mailing Address - Fax:313-576-8767
Practice Address - Street 1:4100 JOHN R
Practice Address - Street 2:KARMANOS CANCER CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:313-576-8767
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078637207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013960384Medicaid
MI11-0950041-2OtherBCBS PIN #
MI5214879Medicaid
MI5209663Medicaid
MI5223420Medicaid
MIP57450001Medicare PIN
MI0P30630584Medicare PIN
MIN40170109Medicare PIN
MI5223420Medicaid
MI0P30630584Medicare PIN