Individual
DR. SUSAN R STAUDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
B515 MAYO MEMORIAL BUILDING, 420 DELAWARE ST SE, MINNEAPOLIS, MN 55455
(612) 624-9990
(612) 626-2363
Mailing address
1912 FREMONT AVE S, MINNEAPOLIS, MN 55403-2932
(414) 704-1929
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
43128
WI
207LP3000X
Pediatric Anesthesiology Physician
Primary
43128
WI
207LP3000X
Pediatric Anesthesiology Physician
66314
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006006261K
HUMANA
—
05
—
1043266224
—
WI
Enumeration date
05/26/2006
Last updated
10/05/2020
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