Provider Demographics
NPI:1275568933
Name:FARKAS, SUSAN I (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:I
Last Name:FARKAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZSUZSANNA
Other - Middle Name:
Other - Last Name:ILLOVSZKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3641
Mailing Address - Country:US
Mailing Address - Phone:701-234-2371
Mailing Address - Fax:701-234-3813
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2371
Practice Address - Fax:701-234-3813
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9901207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN741121900Medicaid
ND13309Medicaid
H00388Medicare UPIN
NDN25153Medicare PIN
ND13309Medicaid
NDP00178796Medicare PIN