Provider Demographics
NPI:1316041965
Name:KILMER, SUZANNE L (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:KILMER
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 1:3835 J STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5520
Mailing Address - Country:US
Mailing Address - Phone:916-456-0400
Mailing Address - Fax:916-340-0621
Practice Address - Street 1:3835 J STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5520
Practice Address - Country:US
Practice Address - Phone:916-456-0400
Practice Address - Fax:916-340-0621
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63455207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G634550OtherBCBS
F02876Medicare UPIN
CAZZZ14636ZMedicare PIN