Provider Demographics
NPI:1588798706
Name:PEARCE, SUSANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:PEARCE
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 1:324 W. SUPERIOR ST
Mailing Address - Street 2:SUITE 625
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-727-0080
Mailing Address - Fax:218-727-2322
Practice Address - Street 1:324 W. SUPERIOR ST
Practice Address - Street 2:SUITE 625
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-727-0080
Practice Address - Fax:218-727-2322
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN568595800Medicaid
MN110006579Medicare ID - Type Unspecified
MN568595800Medicaid