Provider Demographics
NPI:1508900267
Name:SUSON, KRISTINA D (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:D
Last Name:SUSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:PEDIATRIC UROLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-5588
Mailing Address - Fax:313-993-8738
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:PEDIATRIC UROLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5588
Practice Address - Fax:313-993-8738
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-08-08
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Provider Licenses
StateLicense IDTaxonomies
MI43011017032088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology