Provider Demographics
NPI:1093700247
Name:KLEMMER, SUSAN HANSON (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HANSON
Last Name:KLEMMER
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 1:6080 DIXIE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3493
Mailing Address - Country:US
Mailing Address - Phone:248-623-9700
Mailing Address - Fax:248-623-8996
Practice Address - Street 1:6080 DIXIE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3493
Practice Address - Country:US
Practice Address - Phone:248-623-9700
Practice Address - Fax:248-623-8996
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISK042375207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0706301461OtherBCBSM
MI0706301461OtherBCBSM
MI0630146Medicare PIN