Provider Demographics
NPI:1457972499
Name:SPENCER, MEGAN SUSANNE (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUSANNE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32652 KNO
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-9805
Mailing Address - Country:US
Mailing Address - Phone:269-782-4141
Mailing Address - Fax:269-783-1236
Practice Address - Street 1:32652 KNO
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9805
Practice Address - Country:US
Practice Address - Phone:269-782-4141
Practice Address - Fax:269-783-1236
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101027609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program