Provider Demographics
NPI:1003874587
Name:LESSNER-BOESLER, SUSAN MARIE (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:LESSNER-BOESLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48124 ROUNDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5908
Mailing Address - Country:US
Mailing Address - Phone:734-981-2653
Mailing Address - Fax:734-981-2653
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4800
Practice Address - Fax:517-796-6410
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202443207P00000X
MI5101012764207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG58783Medicare UPIN