Provider Demographics
NPI:1124219316
Name:TIBUNI-SANDERS, SUSAN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHELLE
Last Name:TIBUNI-SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MICHELLE
Other - Last Name:TIBUNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:175 CLIFFORD TER
Mailing Address - Street 2:#4
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4530
Mailing Address - Country:US
Mailing Address - Phone:713-548-4319
Mailing Address - Fax:
Practice Address - Street 1:2235 GEARY
Practice Address - Street 2:6 NORTHWEST
Practice Address - City:SAN FRANSCICO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-833-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP2-0028957207R00000X
CAA123761207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine