Provider Demographics
NPI:1063245314
Name:SUJI SUB INC
Entity type:Organization
Organization Name:SUJI SUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BFR EXPERT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALASDAIR-RONALD
Authorized Official - Last Name:MACPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-600-3210
Mailing Address - Street 1:7004 TAVISTOCK LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7731
Mailing Address - Country:US
Mailing Address - Phone:313-600-3210
Mailing Address - Fax:
Practice Address - Street 1:1447 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5138
Practice Address - Country:US
Practice Address - Phone:313-600-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Single Specialty