Provider Demographics
NPI:1114110376
Name:BEYDOUN, SUZAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:
Last Name:BEYDOUN
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 LUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 HAGGERTY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5539
Practice Address - Country:US
Practice Address - Phone:734-981-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine