Individual
STUART KOPPELA-SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLC
Contact information
Practice address
4000 W WALTON BLVD, WATERFORD, MI 48329-4191
(248) 461-6266
Mailing address
3490 LEVEE ST, WATERFORD, MI 48329-2252
(248) 802-9685
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451022847
MI
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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