Individual
DEREK SUSALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
441 S LIVERNOIS RD, ROCHESTER HILLS, MI 48307-2584
(248) 608-8800
Mailing address
615 WOODGLEN CIR APT 206, AUBURN HILLS, MI 48326-4526
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008192
MI
Other
Enumeration date
05/07/2017
Last updated
05/07/2017
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