Provider Demographics
NPI:1801889357
Name:BLATTEL, SUSAN AKERS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:AKERS
Last Name:BLATTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:AKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 CHESTERFIELD PKWY E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2167
Mailing Address - Country:US
Mailing Address - Phone:636-532-2422
Mailing Address - Fax:636-532-2425
Practice Address - Street 1:1001 CHESTERFIELD PKWY E
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2167
Practice Address - Country:US
Practice Address - Phone:636-532-2422
Practice Address - Fax:636-532-2425
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101563207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80087Medicare UPIN
MO003013449Medicare ID - Type Unspecified