Individual
MRS. SUSAN R. ILLIKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
5325 ELLIOTT DR, YPSILANTI, MI 48197-8633
(734) 712-8000
(734) 712-8010
Mailing address
5325 ELLIOTT DR, YPSILANTI, MI 48197-8633
(734) 712-8000
(734) 712-8010
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704199428
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E01050
BCBS GROUP PIN
MI
01
—
5008604980
BCBS INDIVIDUAL PIN
MI
01
—
7451595
AETNA
MI
Enumeration date
07/05/2005
Last updated
01/29/2009
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