Individual
SUSAN MICHELLE SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8001 YOUREE DR, SUITE 540, SHREVEPORT, LA 71115-2302
(318) 212-3810
(318) 212-3815
Mailing address
8001 YOUREE DR, SUITE 540, SHREVEPORT, LA 71115-2302
(318) 212-3810
(318) 212-3815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
023219
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1495590
—
LA
Enumeration date
07/01/2006
Last updated
12/18/2007
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