Provider Demographics
NPI:1558314823
Name:SANTELLE, SUSAN LAURA (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LAURA
Last Name:SANTELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1475
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:7007 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2620
Practice Address - Country:US
Practice Address - Phone:414-352-3341
Practice Address - Fax:414-247-4772
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI23862020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB56289Medicare UPIN