Provider Demographics
NPI:1073534871
Name:BELLEFLEUR, SUSAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:BELLEFLEUR
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 1:15500 19 MILE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6330
Mailing Address - Country:US
Mailing Address - Phone:586-263-6464
Mailing Address - Fax:586-263-8491
Practice Address - Street 1:15500 19 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6330
Practice Address - Country:US
Practice Address - Phone:586-263-6464
Practice Address - Fax:586-263-8491
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407630208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3281756Medicaid
MIF18652Medicare UPIN
MI3281756Medicaid