Provider Demographics
NPI:1003253824
Name:DUNDAS, SUSAN HOPE (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HOPE
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S STATE ST STE 215
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-7103
Mailing Address - Country:US
Mailing Address - Phone:734-547-3990
Mailing Address - Fax:734-547-3980
Practice Address - Street 1:2395 JOLLY RD STE 160
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5977
Practice Address - Country:US
Practice Address - Phone:517-301-5011
Practice Address - Fax:517-879-4889
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255429320Medicaid
MI1003253824Medicaid
MI1437355898Medicaid
MI1487925624Medicaid
MI1003253824Medicaid