Basic Information
| Provider Information | |||||||||
| NPI: | 1407848385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAY-HUFFORD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3922 WOODLEY RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912121 | ||||||||
| FaxNumber: | 4194796017 | ||||||||
| Practice Location | |||||||||
| Address1: | 3922 WOODLEY RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912121 | ||||||||
| FaxNumber: | 4194796017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35057562 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00424 | 01 | OH | PHC | OTHER | 370012697 | 01 | OH | RRMC | OTHER | 472341 | 01 | MI | AETNA | OTHER | 0721339 | 05 | OH | MEDICAID | 12-03669 | 01 | MI | UHC | OTHER | 3505802281 | 01 | MI | BCBS MI | OTHER | 000000141199 | 01 | OH | ANTHEM | OTHER | 12-01298 | 01 | OH | UHC | OTHER | 17290 | 01 | MI | HPM | OTHER | 000000221694 | 01 | MI | ANTHEM | OTHER | 0634103 | 01 | OH | AETNA | OTHER |