Provider Demographics
NPI:1164426797
Name:CHOW, SUSANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:MARIE
Last Name:CHOW
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:STE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2338
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:913-262-3295
Practice Address - Street 1:5721 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-498-7164
Practice Address - Fax:913-498-7899
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-233232085R0202X
MOR5N722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202863130Medicaid
KS100121970CMedicaid
MO202863130Medicaid
KSO57892Medicare PIN
MOJ962139Medicare PIN
KSJ962139AMedicare PIN