Sookkasikon, Supak

Sookkasikon, Supak is an sole proprietor health care provider with primary practice located at 4050 W Maple Rd Suite 101, Bloomfield Township MI 48301-3148. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Sookkasikon, Supak can be contacted via phone (248) 885-8211.

Contact Information

Primary practice address
4050 W Maple Rd Suite 101 Bloomfield Township MI 48301-3148
Phone: (248) 885-8211
Fax: (248) 885-8357
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4301083253 Michigan

Profile Details

NPI number 1649376922
LBN Legal business name Sookkasikon, Supak
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 15th, 2006
Last updated Feb 28th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649376922 NPPES
Michigan Other 5315028426 CONTROLLED SUBSTANCE

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