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MALLORY KRISTEN SUAZO MD
NPI 1740962125
Student in an Organized Health Care Education/Training Program in Ann Arbor, MI

Active since August 03, 2023PECOS Enrolled
1000 WALL ST, ANN ARBOR, MI 48105(248) 767-6495 Get Directions Write a Review

NPPES record last updated: June 10, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 10, 2025, Sep 4, 2024 (2 updates tracked since 2024).

About Mallory Kristen Suazo Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MALLORY KRISTEN SUAZO MD (NPI 1740962125) is an individual student in an organized health care education/training program in Ann Arbor, Michigan, licensed in Michigan (4351052212) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1740962125
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameMALLORY KRISTEN SUAZOCredential: MD
Location Address1000 WALL STAnn Arbor, MI 48105-1986
Mailing Address1000 Wall StAnn Arbor, MI 48105-1986 · (734) 763-8122
Phone(248) 767-6495
Sole ProprietorNo
Enumeration DateAugust 3, 2023
Last NPPES UpdateJune 10, 20252 updates tracked since enumeration
NPPES CertifiedJune 10, 2025
✔ NPI 1740962125 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in MI · 4351052212
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1000 WALL ST, Ann Arbor, MI 48105
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallory Kristen Suazo Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHERRY H DAY OD
Optometrist
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190
MONTE ANTHONY DELMONTE MD
Ophthalmology
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190
MATTHEW DRIBAN MD
Student in an Organized Health Care Education/Training Program
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 763-8122
CHERIE A FARKASH OD
Optometrist
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190
BRITTANY A SIMMONS M.D.
Ophthalmology
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190
ALEXANDER DOMINIC VALENTINE MD
Ophthalmology
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190
CYNTHIA JIANG HODSON MD
Ophthalmology
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190
SEAN OWEN HANSEN MD
Ophthalmology
1000 WALL ST
ANN ARBOR, MI 48105
Washtenaw County (734) 764-4190

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mallory Suazo's NPI number?

The NPI number for Mallory Suazo is 1740962125. It was assigned to this individual provider in the NPPES registry on August 3, 2023.

Where is Mallory Suazo located?

Mallory Suazo practices at 1000 Wall St, Ann Arbor, MI 48105. The listed phone number is (248) 767-6495.

What is Mallory Suazo's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Mallory Suazo enrolled in Medicare?

Yes. Mallory Suazo is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mallory Suazo was last updated on June 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.