Provider Demographics
NPI:1497731400
Name:DORENBUSCH, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DORENBUSCH
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 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-375-3000
Mailing Address - Fax:812-375-3477
Practice Address - Street 1:3183 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3164
Practice Address - Country:US
Practice Address - Phone:812-372-1581
Practice Address - Fax:812-376-4028
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000984533OtherANTHEM PIN
IN100384130AMedicaid
IN000000511861OtherANTHEM
IN000000511861OtherANTHEM
IN000000984533OtherANTHEM PIN
INE88638Medicare UPIN