Active NPI
Yi Chul Sul, MD
- Neurology Physician
- Roseville, MI
National Provider Identifier
1851492318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 4301039780
- Practice address
- 25195 Kelly Rd
Suite B
Roseville, MI 48066-4909 - Phone
- (586) 777-3370
- Fax
- (586) 777-3380
- NPI assigned
- Sep 26, 2006
- Last updated
- Mar 2, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 4301039780 | MI | Primary |
| Neurology with Special Qualifications in Child Neurology Physician | 2084N0402X | C50870 | CA |
Addresses
Primary practice location
25195 Kelly Rd
Suite B
Roseville, MI 48066-4909
Mailing address
25195 Kelly Rd
Suite B
Roseville, MI 48066-4909
Phone (586) 777-3370
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1395373 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C50870 | CA | MD | Neurology with Special Qualifications in Child Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allergy Clinic of Warren PC | Past | Accepting new patients |
Interoperability endpoints
- ysul63409@direct.hfhs.org
Organizations & group practices 1
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.
-
- Allergy & Immunology Physician
- Warren, MI
- NPI 1750599569
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488412800000",
"number": "1851492318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25195 KELLY RD",
"address_2": "SUITE B",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480664909",
"telephone_number": "586-777-3370",
"fax_number": "586-777-3380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25195 KELLY RD",
"address_2": "SUITE B",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480664909",
"telephone_number": "586-777-3370",
"fax_number": "586-777-3380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUL",
"first_name": "YI",
"middle_name": "CHUL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2017-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "4301039780",
"primary": true
},
{
"code": "2084N0402X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
"state": "CA",
"license": "C50870",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1395373",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.