# A3 MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366798373
- **Authorized official:** SUPAK SOOKKASIKON MD (NOT APPLICABLE)
- **Authorized official phone:** (248) 885-8211

## Contact information

- **Practice address:** 4050 W MAPLE ROAD, SUITE 101, BLOOMFIELD, MI 48301
- **Practice address phone:** (248) 885-8211
- **Practice address fax:** (248) 855-8357
- **Mailing address:** 4050 W MAPLE ROAD, SUITE 101, BLOOMFIELD, MI 48301
- **Mailing address phone:** (248) 885-8211
- **Mailing address fax:** (248) 855-8357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 4301083253 | MI | — |
| 207R00000X | Internal Medicine Physician | 4301080609 | MI | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/27/2012
- **Last updated:** 10/14/2022