Individual
DR. SUSAN E PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9334
(574) 239-1569
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9334
(574) 239-1569
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01052506A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200283290
—
IN
Enumeration date
10/26/2005
Last updated
08/03/2016
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