Provider Demographics
NPI:1841209426
Name:GAIKAZIAN, SUSANNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:S
Last Name:GAIKAZIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSANNA
Other - Middle Name:S
Other - Last Name:GAYKAZYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:248-551-6910
Practice Address - Street 1:8260 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4156
Practice Address - Country:US
Practice Address - Phone:239-437-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156581207RH0000X, 207RX0202X, 207RX0202X
MI4301081577207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP49050Medicare PIN