Individual
SUSAN MARIE MOORE-RIESBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
28070 COUNTY ROAD 24, ELKHART, IN 46517-9717
(574) 273-8053
(574) 273-8056
Mailing address
PO BOX 175, GRANGER, IN 46530-0175
(574) 273-8053
(574) 273-8056
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001290A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100366000
—
IN
Enumeration date
12/19/2006
Last updated
10/30/2020
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