Provider Demographics
NPI:1093796476
Name:LAW, SUZANNE A (DO)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:LAW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:14695 PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1920
Mailing Address - Country:US
Mailing Address - Phone:231-547-2812
Mailing Address - Fax:231-392-7337
Practice Address - Street 1:818 W KING ST
Practice Address - Street 2:STE 201
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2116
Practice Address - Country:US
Practice Address - Phone:989-723-3168
Practice Address - Fax:989-725-2962
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2022-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013544208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093796476Medicaid
MI1093796476Medicaid
MIN53550121Medicare PIN