Provider Demographics
NPI:1689731861
Name:KREISBERG, SUZANNE HUMPHRIES (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:HUMPHRIES
Last Name:KREISBERG
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 1:1515 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3790
Mailing Address - Country:US
Mailing Address - Phone:269-493-7026
Mailing Address - Fax:
Practice Address - Street 1:4770 REGENT BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2445
Practice Address - Country:US
Practice Address - Phone:972-916-3260
Practice Address - Fax:972-916-3209
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7269207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH66273Medicare UPIN