Individual
SUZANNE M RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220-3712
(920) 320-2011
Mailing address
PO BOX 2290, MANITOWOC, WI 54221-2290
(920) 320-2591
Taxonomy
Speciality
Code
Description
License number
State
246Q00000X
Pathology Specialist/Technologist
Primary
12189
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220027739
MEDICARE RAILROAD
WI
05
—
31810700
—
WI
Enumeration date
08/21/2006
Last updated
10/27/2011
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