Intan, Susiani

Intan, Susiani is an individual health care provider with primary practice located at 2801 W Kinnickinnic River Pkwy , Milwaukee WI 53215-3669. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Intan, Susiani can be contacted via phone (414) 385-1922.

Contact Information

Primary practice address
2801 W Kinnickinnic River Pkwy Milwaukee WI 53215-3669
Phone: (414) 385-1922
Fax: (414) 385-1988
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD60712039 Washington
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD60712039 Washington
Allopathic & Osteopathic Physicians / Neurology 2084N0400X A168657 California
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 62449 Wisconsin

Profile Details

NPI number 1114274529
LBN Legal business name Intan, Susiani
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 6th, 2012
Last updated Mar 1st, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114274529 NPPES
Washington Other G8966408 WVH PTAN
Washington MEDICAID 1114274529 WVH PTAN
Washington Other G8966407 WVH PTAN

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