Provider Demographics
NPI:1053318030
Name:FLEET, SUSAN BONFILI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BONFILI
Last Name:FLEET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 SPRINGHILL BUSINESS PARK STE 201
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1263
Mailing Address - Country:US
Mailing Address - Phone:251-873-6192
Mailing Address - Fax:251-873-6193
Practice Address - Street 1:3601 SPRINGHILL BUSINESS PARK STE 201
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1263
Practice Address - Country:US
Practice Address - Phone:251-873-6192
Practice Address - Fax:251-873-6193
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16183207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1053318030OtherNPI
AL000016183Medicaid
AL051535228OtherMEDICARE PTAN
AL000016183Medicaid
AL051535228OtherMEDICARE PTAN