Provider Demographics
NPI:1770824732
Name:EZELL, SUSAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:EZELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SUOZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5100 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1607
Mailing Address - Country:US
Mailing Address - Phone:614-544-1000
Mailing Address - Fax:614-544-1751
Practice Address - Street 1:20 NE SAINT LUKES BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6001
Practice Address - Country:US
Practice Address - Phone:816-282-7809
Practice Address - Fax:816-282-7870
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-39880207V00000X
MO2017010647207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology