Provider Demographics
NPI:1346268141
Name:MADERIC, SUSAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:F
Last Name:MADERIC
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 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10235 HIGHWAY 421 N
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:KY
Practice Address - Zip Code:40045
Practice Address - Country:US
Practice Address - Phone:502-268-5500
Practice Address - Fax:502-268-3600
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068627A207Q00000X
KY39244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50014782OtherPASSPORT
INM400071155OtherMEDICARE
IN201067830Medicaid
IN7795717OtherAETNA
KY64108541Medicaid
KY675248OtherANTHEM
KYK019983OtherMEDICARE EFFECTIVE 10/55/200
KY2842542000OtherPASSPORT ADVANTAGE