Provider Demographics
NPI:1730315128
Name:SUSANA MAY MD LLC
Entity Type:Organization
Organization Name:SUSANA MAY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-852-7490
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-0739
Mailing Address - Country:US
Mailing Address - Phone:305-852-7490
Mailing Address - Fax:305-743-5383
Practice Address - Street 1:5701 OVERSEAS HWY
Practice Address - Street 2:SUITE 17
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2784
Practice Address - Country:US
Practice Address - Phone:305-743-2253
Practice Address - Fax:305-743-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62312207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18085OtherBCBS
FL370998100Medicaid
FL18085OtherBCBS