Provider Demographics
NPI:1770787178
Name:SUSSMAN, RACHEL F (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:F
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36500 FORD RD STE 212
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3769
Mailing Address - Country:US
Mailing Address - Phone:586-997-0999
Mailing Address - Fax:586-997-0990
Practice Address - Street 1:390 PARK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3400
Practice Address - Country:US
Practice Address - Phone:586-558-8346
Practice Address - Fax:586-279-2124
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015250202K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2962001Medicare PIN