Individual
SUSAN M VITALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
737 BROADWAY N, FARGO, ND 58122-0001
(701) 234-4811
(701) 234-6979
Mailing address
665 3RD ST SW, PERHAM, MN 56573-1108
(218) 347-1200
(218) 346-4043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31744
MN
Other
Enumeration date
07/22/2006
Last updated
12/27/2007
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