Provider Demographics
NPI:1922025865
Name:LUGO-MEDINA, SUZETTE (MD)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:LUGO-MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1131 N OSSEO RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9714
Mailing Address - Country:US
Mailing Address - Phone:517-523-3695
Mailing Address - Fax:517-523-3311
Practice Address - Street 1:358 E CHICAGO ST STE 204E
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2073
Practice Address - Country:US
Practice Address - Phone:517-617-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISL0789822084P0804X
MI43010789822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4653631Medicaid
MI4653631Medicaid
MIN90820002Medicare PIN
MI0N90820Medicare ID - Type Unspecified