Provider Demographics
NPI:1528640778
Name:SUGG, KYLE AUSTIN (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:AUSTIN
Last Name:SUGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9007 WOODLORE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3499
Mailing Address - Country:US
Mailing Address - Phone:734-812-1208
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 2E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-993-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program