MEDICARE: DR. SUE DIAMOND MUGGAR MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	MD493366	PA
3	2084P0800X	Psychiatry Physician	94823	GA

General Provider Information

NPI Number	:	1568048684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUE DIAMOND MUGGAR MD

Provider Business Mailing Address
First Line	:	10524 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:	478-412-0411
Fax Number	:	216-844-4741

Provider Business Practice Location Address
First Line	:	10524 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:	478-412-0411
Fax Number	:	216-844-4741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	06/10/2026

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