Provider Demographics
NPI:1295830792
Name:CALDWELL, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CALDWELL
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:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-964-6204
Practice Address - Street 1:13191 SCHAVEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9036
Practice Address - Country:US
Practice Address - Phone:517-669-9109
Practice Address - Fax:517-669-9839
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0801900392OtherBCBS INDIVIDUAL PIN
MI4125970Medicaid
MIH21743Medicare UPIN
MIN16670026Medicare PIN
MEN17340001Medicare PIN