Provider Demographics
NPI:1821031634
Name:HUNT-LATTIN, SUSAN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:HUNT-LATTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9825 HOSPITAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4769
Mailing Address - Country:US
Mailing Address - Phone:763-780-6699
Mailing Address - Fax:763-420-0506
Practice Address - Street 1:9825 HOSPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4769
Practice Address - Country:US
Practice Address - Phone:763-780-6699
Practice Address - Fax:763-420-0506
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN48918208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI56225Medicare UPIN