Stack, Susan M

Stack, Susan M is an individual health care provider with primary practice located at 1373 E Sr 62 , Madison IN 47250. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Stack, Susan M can be contacted via phone (812) 801-0300.

Contact Information

Primary practice address
1373 E Sr 62 Madison IN 47250
Phone: (812) 801-0300
Fax: (812) 801-0585
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 01033162 Indiana

Profile Details

NPI number 1588696314
LBN Legal business name Stack, Susan M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Feb 20th, 2019 - about 5 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 1588696314 NPPES
Indiana Other 410015P SIHO
Indiana Other 000000042214 SIHO
Indiana MEDICAID 100148860A SIHO
Indiana Other 1082593 SIHO
Indiana Other 4370872 SIHO
Indiana MEDICAID 64759780 SIHO

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