Individual
SUSAN THERESE FEDEWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4800
(517) 796-6410
Mailing address
DEPARTMENT 272801, PO BOX 67000, DETROIT, MI 48267-2728
(517) 841-6913
(517) 841-6917
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101010021
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114873751
—
MI
01
—
P00312682
RR MEDICARE
MI
Enumeration date
05/24/2006
Last updated
11/23/2007
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