Park, Susan E
Park, Susan E is an individual health care provider with primary practice located at 211 N Eddy St , South Bend IN 46617-2808. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Park, Susan E can be contacted via phone (574) 237-9334.Contact Information
Primary practice address
211 N Eddy St
South Bend IN 46617-2808
Phone: (574) 237-9334
Fax: (574) 239-1569
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 01052506A | Indiana |
Profile Details
| NPI number | 1184614638 |
|---|---|
| LBN Legal business name | Park, Susan E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 26th, 2005 |
| Last updated | Aug 3rd, 2016 - about 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184614638 | NPPES |
| Indiana | MEDICAID | 200283290 |
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