Provider Demographics
NPI:1518279058
Name:MICHALOWSKI, SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MICHALOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20173 W WHIPPLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1755
Mailing Address - Country:US
Mailing Address - Phone:919-244-8148
Mailing Address - Fax:
Practice Address - Street 1:440 BURROUGHS ST STE 446
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3429
Practice Address - Country:US
Practice Address - Phone:313-870-1727
Practice Address - Fax:313-870-1701
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCABMG2009104170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics