Provider Demographics
NPI:1194121772
Name:SUHRE, JEFFREY ALBERT
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALBERT
Last Name:SUHRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18210 MIDDLEBELT RD APT 104
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3623
Mailing Address - Country:US
Mailing Address - Phone:313-727-1180
Mailing Address - Fax:
Practice Address - Street 1:18210 MIDDLEBELT RD APT 104
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3623
Practice Address - Country:US
Practice Address - Phone:313-727-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470179739163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse