Provider Demographics
NPI:1093780611
Name:HAROLD, SUSAN ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:HAROLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6001 W OUTER DR
Mailing Address - Street 2:SUITE 429
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2614
Mailing Address - Country:US
Mailing Address - Phone:313-861-3500
Mailing Address - Fax:313-861-2697
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE 429
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:313-861-3500
Practice Address - Fax:313-861-2697
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MISH032837207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2097527Medicaid
MI2097527Medicaid
MI0827262Medicare ID - Type Unspecified