Provider Demographics
NPI:1689616203
Name:GIOVANNI, SUSAN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:GIOVANNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N RIVERVIEW ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4265
Mailing Address - Country:US
Mailing Address - Phone:316-616-1055
Mailing Address - Fax:855-633-0585
Practice Address - Street 1:345 N RIVERVIEW ST STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4265
Practice Address - Country:US
Practice Address - Phone:316-616-1055
Practice Address - Fax:855-633-0585
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG24862Medicare UPIN
KS104361Medicare ID - Type Unspecified