Provider Demographics
NPI:1467439257
Name:SCHAEFER, SUZANNE M
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:3850 PARK NICOLLET BLVD
Practice Address - Street 2:PARK NICOLLET CLINIC - SLP
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-3025
Practice Address - Fax:952-993-1937
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN33223207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine