Organization
A3 MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUPAK SOOKKASIKON MD (NOT APPLICABLE)
(248) 885-8211
Entity
Organization
Contact information
Practice address
4050 W MAPLE ROAD, SUITE 101, BLOOMFIELD, MI 48301
(248) 885-8211
(248) 855-8357
Mailing address
4050 W MAPLE ROAD, SUITE 101, BLOOMFIELD, MI 48301
(248) 885-8211
(248) 855-8357
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301083253
MI
207R00000X
Internal Medicine Physician
Primary
4301080609
MI
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
07/27/2012
Last updated
10/14/2022
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