Provider Demographics
NPI:1841255585
Name:SULESKEY, JON F (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:F
Last Name:SULESKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 FAITH DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2759
Mailing Address - Country:US
Mailing Address - Phone:248-765-0529
Mailing Address - Fax:
Practice Address - Street 1:3512 PRIMROSE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5268
Practice Address - Country:US
Practice Address - Phone:248-852-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011241208800000X
WY12472A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3108957-11Medicaid
MI3108957-11Medicaid