Provider Demographics
NPI:1295773372
Name:BILKA, SUSAN MARIE (CNM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:BILKA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD STE 352
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3712
Mailing Address - Country:US
Mailing Address - Phone:248-849-3041
Mailing Address - Fax:248-849-4106
Practice Address - Street 1:22255 GREENFIELD RD STE 352
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3712
Practice Address - Country:US
Practice Address - Phone:248-849-3041
Practice Address - Fax:248-849-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704154653367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32150025Medicare PIN