Provider Demographics
NPI:1790713576
Name:MCCARTAN, SUSAN ANN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:MCCARTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:KAIB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1300 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-4516
Mailing Address - Country:US
Mailing Address - Phone:602-252-5609
Mailing Address - Fax:602-257-4338
Practice Address - Street 1:1300 S. 10 STREET
Practice Address - Street 2:WESLEY COMMUNITY & HEALTH CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034
Practice Address - Country:US
Practice Address - Phone:602-368-9603
Practice Address - Fax:602-257-4338
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ427907Medicaid
G85266Medicare UPIN