Provider Demographics
NPI:1285646034
Name:KIRKPATRICK, SUSAN HEIDI (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HEIDI
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1695
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-1695
Mailing Address - Country:US
Mailing Address - Phone:626-574-7592
Mailing Address - Fax:626-447-3704
Practice Address - Street 1:20 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3209
Practice Address - Country:US
Practice Address - Phone:626-574-7592
Practice Address - Fax:626-447-3704
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3748213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37480Medicaid
0935724OtherMEDICAL PIN #
U30143Medicare UPIN
CA000E37480Medicaid