Provider Demographics
NPI:1962496661
Name:BURKHEAD, SUSANNA R (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:R
Last Name:BURKHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 359
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47703-0359
Mailing Address - Country:US
Mailing Address - Phone:812-485-1220
Mailing Address - Fax:812-485-8544
Practice Address - Street 1:3700 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47750-0001
Practice Address - Country:US
Practice Address - Phone:812-485-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066004A2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100111320Medicaid
IN200978080Medicaid
G14557Medicare UPIN
INM400031446Medicare PIN