Provider Demographics
NPI:1528005188
Name:SPIELLER, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SPIELLER
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 1:608 E SUNSET DR N
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6451
Mailing Address - Country:US
Mailing Address - Phone:310-351-0497
Mailing Address - Fax:909-793-1705
Practice Address - Street 1:608 E SUNSET DR N
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6451
Practice Address - Country:US
Practice Address - Phone:310-351-0497
Practice Address - Fax:909-793-1705
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG654082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G654080Medicaid
CA00G654086Medicare PIN
CAWG65408WMedicare PIN
CA00G654084Medicare PIN
CA00G654085Medicare PIN
CAWG65408YMedicare PIN
CAF67461Medicare UPIN
CAWG65408XMedicare PIN
CATP016Medicare PIN
CA00G654080Medicaid
CATG053Medicare PIN
CA00G654082Medicare PIN
CATP051Medicare PIN