Michael K Sutley, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9086 Issued in MN

Practice address

825 Nicollet Mall
Suite 707 Medical Arts BLDG
Minneapolis, MN 55402-2606

Phone

(612) 333-3381

Fax

(612) 334-3318

NPI assigned

Dec 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 18, 2015 through Aug 18, 2027

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael K Sutley DDS PA

  dba minneapolis oral & maxillofacial surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Minneapolis, MN
  • NPI 1497890594
  NPD (past) Authorized official
• Northpark Dental

  • Dentist
  • Blaine, MN
  • NPI 1710161500
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316000755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6406 TIMBER RDG",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554391057",
            "telephone_number": "952-944-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 707 MEDICAL ARTS BLDG",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022606",
            "telephone_number": "612-333-3381",
            "fax_number": "612-334-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTLEY",
        "first_name": "MICHAEL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "9086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sustainable Resources Center Inc
• Sustainable Resources Center, Inc.
• Thomas Mark Suszynski, MD, PHD
• Trudy Lynn Sutherland, LICSW
• Kristen Deann Sutley, M.D.
• Sutton Investments, LLP (Healthy For Life Meals)
• Jesse Daniel Sutton, PHARMD, BCIDP
• Makaila Sutton
• Nichol Marie Sutton, M.S.P.T.
• Thomas Matthew Sutton, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.