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Individual

SUSAN R WIERSMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
(216) 286-6341
Mailing address
3605 WARRENSVILLE CENTER RD, SHAKER HTS, OH 44122-5203
(216) 286-6299
(216) 286-6341

Taxonomy

Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
35-051050
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000027183
ANTHEM
OH
01
000000221140
UNISON
OH
01
000000526169
ANTHEM
OH
01
200206560A
OK MEDICAID
OK
01
2056126
BCMH
OH
05
2056126
OH
01
2093513
AETNA
OH
01
364131
WELLCARE
OH
01
742534
BUCKEYE
OH
Enumeration date
07/21/2006
Last updated
10/01/2008
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