Provider Demographics
NPI:1255390308
Name:HAFFERMAN, SUSAN KAY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:HAFFERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7301 OHMS LANE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:350 OSBORNE RD NE
Practice Address - Street 2:UNITY HOSPITAL
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-236-4144
Practice Address - Fax:763-236-4900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45339207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45339OtherMEDICAL LICENSE
MN45339OtherMEDICAL LICENSE
H80909Medicare UPIN