| Doctor Name: | TED SUGIMOTO |
| NPI Number: | 1578579595 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 4301041051 |
| Business Practice Address: | 3950 Hollywood Rd Suite 100 Saint Joseph, MI - 490859159 |
| Business Phone Number: | 2694290900 |
| Business Fax Number: | 2694080996 |
| Mailing Address: | 6416 Deans Hill Rd, BERRIEN CENTER |
| State: | MI |
| Postal Code: | 491029750 |
| Phone Number: | 2694717741 |
| Fax Number: | 2694711581 |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 04/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 4301041051 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |