Provider Demographics
NPI:1225038854
Name:MARLEY BIRD, SUSAN MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:MARLEY BIRD
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 1:615 VALLEY VIEW DR
Mailing Address - Street 2:STE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6150
Mailing Address - Country:US
Mailing Address - Phone:309-762-1072
Mailing Address - Fax:309-762-1094
Practice Address - Street 1:615 VALLEY VIEW DR
Practice Address - Street 2:STE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-762-1072
Practice Address - Fax:309-762-1094
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63988-202085R0202X
IA290662085R0202X
IL036-0881182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0857Medicare PIN
F82465Medicare UPIN
ILL31349Medicare PIN
ILR03931Medicare PIN
IA4933952Medicaid
IL036088118Medicaid
IAI0857Medicare PIN
IA47813OtherWELLMARK
F82465Medicare UPIN
IL8933952Medicaid
IA9933952Medicaid
IL0933952Medicaid
ILL31349Medicare PIN
IA2575472Medicaid
IL0575472Medicaid
IL97668OtherWELLMARK
20143OtherIA HEALTH SOLUTIONS
IL9933952Medicaid
ILR03931Medicare PIN