Provider Demographics
NPI:1316767403
Name:SUHA KASSAB DPM PC
Entity type:Organization
Organization Name:SUHA KASSAB DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABANAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-333-4900
Mailing Address - Street 1:10 W SQUARE LAKE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0468
Mailing Address - Country:US
Mailing Address - Phone:248-333-4900
Mailing Address - Fax:
Practice Address - Street 1:10 W SQUARE LAKE RD STE 300
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0468
Practice Address - Country:US
Practice Address - Phone:248-333-4900
Practice Address - Fax:248-333-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5287600001OtherDME PTAN NUMBER