Provider Demographics
NPI:1972790418
Name:SUSAN E. HAROLD, M.D, P.C.
Entity Type:Organization
Organization Name:SUSAN E. HAROLD, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-561-8711
Mailing Address - Street 1:6001 W OUTER DR
Mailing Address - Street 2:SUITE 429
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2614
Mailing Address - Country:US
Mailing Address - Phone:313-861-3500
Mailing Address - Fax:313-861-8722
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE 429
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:313-861-3500
Practice Address - Fax:313-861-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B43674Medicare UPIN
MI0827262Medicare PIN