Provider Demographics
NPI:1003253824
Name:DUNDAS, SUSAN HOPE (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HOPE
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 LITTLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6224
Mailing Address - Country:US
Mailing Address - Phone:734-368-6984
Mailing Address - Fax:734-203-7799
Practice Address - Street 1:1055 LAURENCE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2964
Practice Address - Country:US
Practice Address - Phone:517-273-4343
Practice Address - Fax:517-273-4344
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006674363A00000X
CAPA65523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255429320Medicaid
MI1003253824Medicaid
MI1437355898Medicaid
MI1487925624Medicaid
MI1003253824Medicaid