Provider Demographics
NPI:1780866194
Name:SUESS, JUDITH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:SUESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0043
Mailing Address - Country:US
Mailing Address - Phone:517-623-6260
Mailing Address - Fax:517-623-6460
Practice Address - Street 1:913 W HOLMES RD
Practice Address - Street 2:SUITE 189
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-272-4357
Practice Address - Fax:517-272-4358
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080C317830OtherBLUE CROSS BLUE SHIELD
MI080C317830OtherBLUE CROSS BLUE SHIELD
MIE24885Medicare UPIN