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NPI Code Detail

MEDICARE: DR. SUSAN CONGER M.D.

MEDICARE: DR. SUSAN CONGER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician101125MO

General Provider Information

NPI Number : 1134195654
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN CONGER M.D.
Provider Business Mailing Address
First Line : 11365 DORSETT RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3411
Country : US
Telephone Number : 314-872-6400
Fax Number : 314-872-6500
Provider Business Practice Location Address
First Line : 11365 DORSETT RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3411
Country : US
Telephone Number : 314-872-6400
Fax Number : 314-872-6500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 07/09/2007

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