Provider Demographics
NPI:1811906415
Name:SALTZMAN, SUSAN LEE (NP)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:SALTZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ERTING
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP-BC
Mailing Address - Street 1:3650 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4290
Mailing Address - Country:US
Mailing Address - Phone:248-462-5288
Mailing Address - Fax:248-674-7157
Practice Address - Street 1:3650 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4290
Practice Address - Country:US
Practice Address - Phone:248-674-4630
Practice Address - Fax:248-674-7157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247975363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P16700-009Medicare ID - Type UnspecifiedMEDICARE