Provider Demographics
NPI:1285635193
Name:TROUT, SUSAN WONSIEWICZ (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WONSIEWICZ
Last Name:TROUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-321-7115
Mailing Address - Fax:303-321-9519
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-321-7115
Practice Address - Fax:303-321-9519
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41047207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90119Medicare UPIN