Provider Demographics
NPI:1255526984
Name:ARCHAMBAULT, SUZANNE M (PA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:ARCHAMBAULT
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-8078
Mailing Address - Fax:313-916-9867
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-8078
Practice Address - Fax:313-916-9867
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2024-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N33470Medicare PIN