Provider Demographics
NPI:1619085040
Name:IVEY, SUSAN HOUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HOUGH
Last Name:IVEY
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 1:15118 WILLOWWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9151
Mailing Address - Country:US
Mailing Address - Phone:231-725-4105
Mailing Address - Fax:
Practice Address - Street 1:15118 WILLOWWOOD CT
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9151
Practice Address - Country:US
Practice Address - Phone:231-725-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050691207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine