Organization
SUSAN H WEINKLE, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN HOLLOWAY WEINKLE M.D. (OWNER)
(941) 794-5432
Entity
Organization
Contact information
Practice address
5601 21ST AVE W, STE B, BRADENTON, FL 34209-5642
(941) 794-5432
(941) 794-5682
Mailing address
5601 21ST AVE W, STE B, BRADENTON, FL 34209-5642
(941) 794-5432
(941) 794-5682
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
45450
FL
207ND0101X
MOHS-Micrographic Surgery Physician
45450
FL
207NS0135X
Procedural Dermatology Physician
45450
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070005597
RAILROAD MEDICARE
FL
01
—
DE5714
RAILROAD MEDICARE PTAN
FL
01
—
P00301379
RAILROAD MEDICARE PIN
FL
Enumeration date
05/07/2007
Last updated
06/02/2011
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