Individual
SUSIANI INTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, MILWAUKEE, WI 53215-3669
(414) 385-1922
(414) 385-1988
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207WX0109X
Neuro-ophthalmology Physician
Primary
62499
WI
2084N0400X
Neurology Physician
62449
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100038273
—
WI
05
—
1114274529
—
WA
01
—
G8966407
WVH PTAN
WA
01
—
G8966408
WVH PTAN
WA
Enumeration date
08/06/2012
Last updated
10/14/2024
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