Provider Demographics
NPI:1710175179
Name:FLICK, SUSAN M (CNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:FLICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-3009
Mailing Address - Fax:216-844-1900
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:LAKESIDE 4TH FLOOR UROLOGY SUITE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3085
Practice Address - Fax:216-844-7735
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09704NP363LA2200X
OHCOA.09704-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH464794OtherWELLCARE
OH2839343Medicaid
OHFLNP28141Medicare PIN
OH464794OtherWELLCARE