Provider Demographics
NPI:1700969417
Name:SUS PROFESSIONAL MEDICAL SERVICE PLLC
Entity Type:Organization
Organization Name:SUS PROFESSIONAL MEDICAL SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HUEI YEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-652-9666
Mailing Address - Street 1:455 S LIVERNOIS RD
Mailing Address - Street 2:STE A-23
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2578
Mailing Address - Country:US
Mailing Address - Phone:248-652-9666
Mailing Address - Fax:248-652-9660
Practice Address - Street 1:455 S LIVERNOIS RD
Practice Address - Street 2:STE A-23
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2578
Practice Address - Country:US
Practice Address - Phone:248-652-9666
Practice Address - Fax:248-652-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043793207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4404206Medicaid
MION46520Medicare ID - Type Unspecified
MIB49524Medicare UPIN