Provider Demographics
NPI:1750357141
Name:JOSEPH, SUSAN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:W2850 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2702
Mailing Address - Country:US
Mailing Address - Phone:920-467-1800
Mailing Address - Fax:920-467-1900
Practice Address - Street 1:W2850 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085
Practice Address - Country:US
Practice Address - Phone:920-467-1800
Practice Address - Fax:920-467-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI31334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31626800Medicaid
WI31626800Medicaid
F05694Medicare UPIN