Provider Demographics
NPI:1982655957
Name:ABRAHAM, SUZANNE (DPM)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:HENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1701 E THOMAS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7646
Mailing Address - Country:US
Mailing Address - Phone:602-251-3113
Mailing Address - Fax:602-251-3114
Practice Address - Street 1:1701 E THOMAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7646
Practice Address - Country:US
Practice Address - Phone:602-251-3113
Practice Address - Fax:602-251-3114
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0609213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist