Provider Demographics
NPI:1538328463
Name:RUSSLER, SUSAN KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:RUSSLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:KATHLEEN
Other - Last Name:BRUCKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:S5W31452 HIDDEN HOLW
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-3258
Mailing Address - Country:US
Mailing Address - Phone:262-201-4032
Mailing Address - Fax:
Practice Address - Street 1:S5W31452 HIDDEN HOLW
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-3258
Practice Address - Country:US
Practice Address - Phone:262-201-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27784-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine