Provider Demographics
NPI:1376500496
Name:SEMAN, SUSAN (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ORCHARD LAKE RD
Mailing Address - Street 2:STE 204
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3425
Mailing Address - Country:US
Mailing Address - Phone:248-470-3916
Mailing Address - Fax:678-666-9686
Practice Address - Street 1:6900 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3405
Practice Address - Country:US
Practice Address - Phone:248-470-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS012179208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4224306Medicaid
MI0256306825OtherBLUE CROSS TRADITIONAL
MI0256306825OtherBLUE CROSS TRADITIONAL
MIH06345Medicare UPIN