Provider Demographics
NPI:1548304785
Name:SUMBUR, MICHAEL PRESTON (LMSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PRESTON
Last Name:SUMBUR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 KNIARD DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48370-3029
Mailing Address - Country:US
Mailing Address - Phone:248-693-4955
Mailing Address - Fax:
Practice Address - Street 1:81 INDIANWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-1595
Practice Address - Country:US
Practice Address - Phone:810-338-6995
Practice Address - Fax:248-693-5885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010813841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION75000Medicare ID - Type Unspecified
MI11586663Medicare UPIN