Provider Demographics
NPI:1174640247
Name:OSHNOCK, SUSAN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:OSHNOCK
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:22101 MOROSS RD
Mailing Address - Street 2:SUITE 132 PROFESSIONAL OFFICE BLDG 1
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2148
Mailing Address - Country:US
Mailing Address - Phone:313-343-3597
Mailing Address - Fax:313-417-2718
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:SUITE 132 PROFESSIONAL OFFICE BLDG 1
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-3597
Practice Address - Fax:313-417-2718
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-08-10
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Provider Licenses
StateLicense IDTaxonomies
MI003151363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35628Medicare UPIN