Provider Demographics
NPI:1699940791
Name:SUTTONS BAY URGENT CARE CENTER
Entity type:Organization
Organization Name:SUTTONS BAY URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-271-6511
Mailing Address - Street 1:508 ST JOSEPH STREET
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9800
Mailing Address - Country:US
Mailing Address - Phone:231-271-6511
Mailing Address - Fax:231-271-6513
Practice Address - Street 1:508 SAINT JOSEPH STREET
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9800
Practice Address - Country:US
Practice Address - Phone:231-271-6511
Practice Address - Fax:231-271-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI453488211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty