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Individual
DR. SUSAN M CARLSON
Active
Individual
DR. SUSAN M CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301075680
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0390552
BCBS IND PIN
MI
01
—
110C910470
BCBS GRP PIN
MI
01
—
155415
GREAT LAKES HTLH PLN
—
05
—
4335118-10
—
MI
01
—
7375227
AETNA PIN
—
Enumeration date
06/14/2006
Last updated
11/07/2014
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