Provider Demographics
NPI:1225005457
Name:FLORES, SUSAN G (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:FLORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GUMABAO-FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:1730 W 25TH ST
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-363-2353
Practice Address - Fax:216-696-7375
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044831F207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10792405OtherCAQH
3610861OtherGROUP ASC MEDICARE
000000184291OtherANTHEM
0119204OtherGROUP MEDICAID
0637236OtherAETNA
OH0799711Medicaid
110213695OtherRR MEDICARE INDIVIDUAL
9273172OtherGROUP MEDICARE
F44831OtherSUMMACARE APEX
102422OtherKAISER
1780634279OtherGROUP NPI
D368301OtherGROUP IND DIAGNOSTICS MED
341783789066OtherCARESOURCE
CA4511OtherRR GROUP MEDICARE
CA4511OtherRR MEDICARE GROUP
D368301OtherGROUP IND DIAGNOSTICS MED
F44831OtherSUMMACARE APEX
OH0799711Medicaid