Provider Demographics
NPI:1700864311
Name:RUSCH, SUSAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:W
Last Name:RUSCH
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 1:2323 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4508
Mailing Address - Country:US
Mailing Address - Phone:149-615-3624
Mailing Address - Fax:
Practice Address - Street 1:5000 W. CHAMBERS STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:56210-1650
Practice Address - Country:US
Practice Address - Phone:414-447-2271
Practice Address - Fax:414-447-2965
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26033207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31797600Medicaid
WI220016801Medicare PIN
WI162450011Medicare PIN
WI017600046Medicare PIN
WI222950010Medicare PIN
WI682300010Medicare PIN
WI017600008Medicare PIN
E83975Medicare UPIN
WI31797600Medicaid
WI132700010Medicare PIN