Provider Demographics
NPI:1740205293
Name:YU, SUSAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 27940
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-0940
Mailing Address - Country:US
Mailing Address - Phone:614-239-9444
Mailing Address - Fax:614-239-1080
Practice Address - Street 1:970 E US HIGHWAY 36 STE B
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1891
Practice Address - Country:US
Practice Address - Phone:937-645-0102
Practice Address - Fax:937-652-4650
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003078213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2056984Medicaid
OH0845531Medicare ID - Type Unspecified
OHU65261Medicare UPIN