Organization
KATHRYN H. SUSSMAN, M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN H SUSSMAN M.D. (PRESIDENT)
(586) 573-4980
Entity
Organization
Contact information
Practice address
28800 RYAN RD, SUITE 320, WARREN, MI 48092-4272
(586) 573-4980
(586) 573-0640
Mailing address
28800 RYAN RD, SUITE 320, WARREN, MI 48092-4272
(586) 573-4980
(586) 573-0640
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0705037252
BLUECROSSBLUE SHIELD
MI
01
—
0E06271
BLUE CARE NETWORK
MI
01
—
KS050808
BLUECROSSBLUESHIELD
MI
Enumeration date
05/03/2007
Last updated
12/11/2007
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