Individual
JARED SUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(303) 501-0705
Mailing address
7713 S ELIZABETH WAY, CENTENNIAL, CO 80122-3315
(303) 501-0705
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02006964A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2019
Last updated
10/20/2022
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