Provider Demographics
NPI:1174586218
Name:HERZBERG, SUSAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6601 WINCHESTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4677
Mailing Address - Country:US
Mailing Address - Phone:816-313-2677
Mailing Address - Fax:816-313-6000
Practice Address - Street 1:4323 WORNALL RD
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3229
Practice Address - Country:US
Practice Address - Phone:816-932-2575
Practice Address - Fax:816-932-2344
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1025122085R0001X
KS04-241962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207930314Medicaid
KS100173260BMedicaid
KS100173260BMedicaid
KS4227660BMedicare PIN
MO4227660AMedicare PIN