Provider Demographics
NPI:1447900709
Name:SUFYAN, YASSER (DPM)
Entity type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:SUFYAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST STE 1012
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2021
Mailing Address - Country:US
Mailing Address - Phone:313-831-6442
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST STE 1012
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2021
Practice Address - Country:US
Practice Address - Phone:313-831-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400580213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery