Provider Demographics
NPI:1639253826
Name:SUSSMAN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1834 STONE AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1306
Mailing Address - Country:US
Mailing Address - Phone:408-995-0102
Mailing Address - Fax:408-995-0190
Practice Address - Street 1:2322 BUTANO DR
Practice Address - Street 2:SUITE 205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0629
Practice Address - Country:US
Practice Address - Phone:916-483-2885
Practice Address - Fax:916-483-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG21001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G210010Medicaid