Provider Demographics
NPI:1831338870
Name:JUDITH A SUESS MD PLLC
Entity type:Organization
Organization Name:JUDITH A SUESS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-333-1709
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0043
Mailing Address - Country:US
Mailing Address - Phone:517-623-6260
Mailing Address - Fax:517-623-6460
Practice Address - Street 1:1210 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1927
Practice Address - Country:US
Practice Address - Phone:517-420-3404
Practice Address - Fax:517-364-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080C317830OtherBLUE CROSS BLUE SHIELD
MI080C317830OtherBLUE CROSS BLUE SHIELD
MIMI1388Medicare PIN