Provider Demographics
NPI:1790003051
Name:BIALECK, SUZANNE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:BIALECK
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 1:13837 SW 109TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3269
Mailing Address - Country:US
Mailing Address - Phone:786-385-8808
Mailing Address - Fax:
Practice Address - Street 1:13837 SW 109TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3269
Practice Address - Country:US
Practice Address - Phone:786-385-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine