Provider Demographics
NPI:1477825594
Name:KATZ-SCHEINKER, SUSAN JOYCE (MBA, RD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOYCE
Last Name:KATZ-SCHEINKER
Suffix:
Gender:F
Credentials:MBA, RD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SCHEINKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBA, RD
Mailing Address - Street 1:5955 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:269-389-9682
Mailing Address - Fax:269-225-8005
Practice Address - Street 1:5955 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-389-9682
Practice Address - Fax:269-225-8005
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI850762133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1020Medicaid
MI1020Medicaid
MI1020102012Medicare NSC
MI1020Medicare PIN