MEDICARE: DR. SUSAN MCCLELLAN ASCH 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	207NP0225X	Pediatric Dermatology Physician	33053	WI
2	208000000X	Pediatrics Physician	31241	MN
3	207NP0225X	Pediatric Dermatology Physician	31241	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841275377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MCCLELLAN ASCH MD

Provider Business Mailing Address
First Line	:	34 NORTH OAKS RD
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-6325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 NORTH OAKS RD
Second Line	:
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-6325
Country	:	US
Telephone Number	:	612-414-7800
Fax Number	:	651-275-3325

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	05/03/2023

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