Provider Demographics
NPI:1396805453
Name:SUSSER, FRANK I (DO)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:I
Last Name:SUSSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:355 E CAMPUS VIEW BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5680
Practice Address - Country:US
Practice Address - Phone:248-824-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7133207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2118194Medicaid
OHSU0811937Medicare PIN
G12793Medicare UPIN
OH4012114Medicare PIN