Individual
SUSAN TACCHERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2600 OAKLAND AVE, ELKHART, IN 46517-1533
(574) 533-1234
(574) 537-2652
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01054417A
IN
2084P0802X
Addiction Psychiatry Physician
01054417A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01054417A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202132
ANTHEM
IN
05
—
200344390
—
IN
01
—
P00184998
RAILROAD MEDICARE PIN
—
Enumeration date
07/09/2006
Last updated
08/09/2011
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