Basic Information
| Provider Information | |||||||||
| NPI: | 1831338870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUDITH A SUESS MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488540043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176236260 | ||||||||
| FaxNumber: | 5176236460 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 W SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489151927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174203404 | ||||||||
| FaxNumber: | 5173647201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2009 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | SUESS | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5173331709 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301064415 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080C317830 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER |