Individual
MICHAEL JOSEPH SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3118 E ORCHID LN, GILBERT, AZ 85296-7826
(480) 254-0941
Mailing address
3118 E ORCHID LN, GILBERT, AZ 85296-7826
(480) 254-0941
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
076265
AZ AHCCCS PROVIDER ID
AZ
Enumeration date
04/08/2007
Last updated
07/08/2007
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