Provider Demographics
NPI:1083835557
Name:FUNK, CONNIE SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SUSAN
Last Name:FUNK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:SUSAN
Other - Last Name:HEUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8730 N NEWPORT PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6626
Mailing Address - Country:US
Mailing Address - Phone:520-575-1542
Mailing Address - Fax:
Practice Address - Street 1:320 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3526
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-388-7151
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine