Provider Demographics
NPI:1902890015
Name:KASSAB, SUHA F (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUHA
Middle Name:F
Last Name:KASSAB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W SQUARE LAKE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0465
Mailing Address - Country:US
Mailing Address - Phone:248-333-4900
Mailing Address - Fax:248-333-4905
Practice Address - Street 1:10 W SQUARE LAKE RD
Practice Address - Street 2:STE. 300
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0465
Practice Address - Country:US
Practice Address - Phone:248-333-4900
Practice Address - Fax:248-333-4905
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK001415213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2592751Medicaid
MI4858252030OtherBC
MI5287600001OtherDME
MI5287600001OtherDME
T34199Medicare UPIN