Provider Demographics
NPI:1609928522
Name:SASSE, SUSANNE L (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:L
Last Name:SASSE
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 1:7710 MERCY ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-393-1338
Mailing Address - Fax:402-393-6924
Practice Address - Street 1:7710 MERCY ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-393-1338
Practice Address - Fax:402-393-6924
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084573713Medicaid
NE1770627457OtherGROUP NPI
NE$$$$$$$$$Medicaid
NE47084573713Medicaid
NE098582001Medicare PIN
NEG19917Medicare UPIN