Individual
MISS SUSAN MARGARET LOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-3242
(651) 254-1553
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
63005
MN
207RG0100X
Gastroenterology Physician
Primary
63005
MN
Other
Enumeration date
06/25/2013
Last updated
03/28/2024
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