Provider Demographics
NPI:1962634675
Name:PARKE, SUSANNAH GRIER (DO)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:GRIER
Last Name:PARKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 LITTLE LAKE DR STE E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6247
Mailing Address - Country:US
Mailing Address - Phone:734-984-3612
Mailing Address - Fax:
Practice Address - Street 1:231 LITTLE LAKE DR STE E
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6247
Practice Address - Country:US
Practice Address - Phone:734-984-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018579208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9588001Medicare PIN