Provider Demographics
NPI:1124012760
Name:ROMADAN, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ROMADAN
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 1:1349 S ROCHESTER RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3152
Mailing Address - Country:US
Mailing Address - Phone:248-446-7711
Mailing Address - Fax:248-429-1569
Practice Address - Street 1:1349 S ROCHESTER RD STE 130
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3152
Practice Address - Country:US
Practice Address - Phone:248-446-7711
Practice Address - Fax:248-429-1569
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA079574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4741064Medicaid
MIP28480008Medicare UPIN