Provider Demographics
NPI:1598735102
Name:HASKELL, SUSAN C (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:HASKELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 LINCOLN PLACE DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 PEACHTREE ST NW STE 800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2512
Practice Address - Country:US
Practice Address - Phone:855-729-2272
Practice Address - Fax:202-833-1725
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0079378207Q00000X
IL036.146713207Q00000X
GA73851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC070557800Medicaid
MD345004000Medicaid
GA00318287BMedicaid