Provider Demographics
NPI:1922336288
Name:CLARKSON, SUSAN TESI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TESI
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:RENEE
Other - Last Name:TESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6602 PENINSULA WAY
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9269
Mailing Address - Country:US
Mailing Address - Phone:517-651-2869
Mailing Address - Fax:
Practice Address - Street 1:6602 PENINSULA WAY
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9269
Practice Address - Country:US
Practice Address - Phone:517-651-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048710208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice