Provider Demographics
NPI:1437170750
Name:KESSLER, SUSAN LYNN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:KESSLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W 13 MILE RD
Mailing Address - Street 2:FSC
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-423-2454
Mailing Address - Fax:248-423-2576
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:FSC
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-423-2454
Practice Address - Fax:248-423-2576
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406679208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350F361320OtherBCBSM
MI3458866Medicaid
MI0F36132104Medicare ID - Type Unspecified
MI3458866Medicaid