Provider Demographics
NPI:1669483269
Name:EILE, SUSAN CAROLE (MD)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:CAROLE
Last Name:EILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13847 E 14TH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2626
Mailing Address - Country:US
Mailing Address - Phone:510-483-2377
Mailing Address - Fax:510-483-2021
Practice Address - Street 1:13847 E 14TH ST STE 214
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2626
Practice Address - Country:US
Practice Address - Phone:510-483-2377
Practice Address - Fax:510-483-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47685207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G476850Medicaid
CA00G476850Medicaid
CA00G476850Medicare PIN