Individual
DR. MICHAEL VITTORIO SUSANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1310 N HEARNE AVE, SHREVEPORT, LA 71107-6516
(318) 676-5111
Mailing address
107 MEDICAL CIR, SULPHUR SPRINGS, TX 75482-2138
(318) 869-2044
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
025874
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041840
—
LA
Enumeration date
06/29/2006
Last updated
05/19/2016
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