Provider Demographics
NPI:1366540338
Name:YATZUN, SUSAN MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:YATZUN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 MOSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:38321-7260
Mailing Address - Country:US
Mailing Address - Phone:731-987-2299
Mailing Address - Fax:
Practice Address - Street 1:660 MOSS CREEK RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:TN
Practice Address - Zip Code:38321-7260
Practice Address - Country:US
Practice Address - Phone:731-987-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000364213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351710Medicaid
TN0177643OtherBCBS OF TN
TN0177643OtherBCBS OF TN
TN3351710Medicare ID - Type Unspecified