Provider Demographics
NPI:1003835877
Name:STROTHEIDE, SUSAN K (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:STROTHEIDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W STATE ST
Mailing Address - Street 2:STE 3A
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-2272
Mailing Address - Country:US
Mailing Address - Phone:616-794-1810
Mailing Address - Fax:616-794-1947
Practice Address - Street 1:1320 W STATE ST
Practice Address - Street 2:STE 3A
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9245
Practice Address - Country:US
Practice Address - Phone:616-794-1810
Practice Address - Fax:616-794-1947
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382454555013OtherTRICARE
MI1598712390OtherGROUP NPI
MIP00343189Medicare ID - Type UnspecifiedRAILROAD
MI0M94800P45Medicare ID - Type UnspecifiedMEDICARE ID
MI1598712390OtherGROUP NPI