Provider Demographics
NPI:1821075995
Name:STEFFY, SUSAN L (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:STEFFY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 CAREW ST
Practice Address - Street 2:STE. 260
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4788
Practice Address - Country:US
Practice Address - Phone:260-373-9250
Practice Address - Fax:260-373-9262
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041631A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4676263OtherAETNA
IL000000264512OtherANTHEM
IN200027920Medicaid
IN3937240010OtherMEDICARE DMEPOS
IN10623OtherPHYSICIANS HEALTH PLAN
00001426252 07OtherUNITED HEALTHCARE
IL000000264512OtherANTHEM
IN10623OtherPHYSICIANS HEALTH PLAN
G14505Medicare UPIN
IN069860HHMedicare PIN