Provider Demographics
NPI:1669445573
Name:SCHUCKERT, SUSAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:SCHUCKERT
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 1:500 W LEOTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6578
Mailing Address - Country:US
Mailing Address - Phone:308-534-4440
Mailing Address - Fax:308-534-7675
Practice Address - Street 1:500 W LEOTA ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6578
Practice Address - Country:US
Practice Address - Phone:308-534-4440
Practice Address - Fax:308-534-7675
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100255554-00Medicaid
NE100255554-00Medicaid