Provider Demographics
NPI:1669462065
Name:ATAMIAN, SUSAN D (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:ATAMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-229-5000
Mailing Address - Fax:320-229-5184
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-229-5000
Practice Address - Fax:320-229-5184
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34545207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
300508900OtherMEDICAL ASSISTANCE
3300075OtherMEDICA HEALTH PLANS
600900OtherARAZ GROUP AMERICAS PPO
HP25401OtherHEALTH PARTNERS
110891OtherU CARE
MN34545OtherLICENSE NUMBER
986002OtherPREFERRED ONE
500R1APOtherBLUE CROSS BLUE SHIELD
6D055APOtherBLUE CROSS BLUE SHIELD
2114081OtherFIRST HEALTH PLAN
2114081OtherFIRST HEALTH PLAN
BA2026676OtherDEA
CU0204Medicare ID - Type UnspecifiedRR
MN34545OtherLICENSE NUMBER
986002OtherPREFERRED ONE