Provider Demographics
NPI:1366988438
Name:SUBURBAN OCCUPATIONAL HEALTH
Entity type:Organization
Organization Name:SUBURBAN OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SISKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-728-4445
Mailing Address - Street 1:29750 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29750 ECORSE RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-3528
Practice Address - Country:US
Practice Address - Phone:734-728-4445
Practice Address - Fax:734-728-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1841318029261QX0100X
MI1962523308261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508913047OtherNPI
MI1962523308OtherNPI
MI1841318029OtherNPI