Provider Demographics
NPI:1407142722
Name:HARITATOS-SEMKO, SUZANNE ANTIONETTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ANTIONETTE
Last Name:HARITATOS-SEMKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:ANTIONETTE
Other - Last Name:HARITATOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3955 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1027
Mailing Address - Country:US
Mailing Address - Phone:765-962-4567
Mailing Address - Fax:
Practice Address - Street 1:3824 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1026
Practice Address - Country:US
Practice Address - Phone:765-965-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000452A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery