MEDICARE: DR. SUSAN M SANTA CRUZ 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	207R00000X	Internal Medicine Physician	C5585	AR

General Provider Information

NPI Number	:	1881788453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M SANTA CRUZ MD

Provider Business Mailing Address
First Line	:	1100 NORTH UNIVERSITY
Second Line	:	SUITE 125
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-6356
Country	:	US
Telephone Number	:	501-664-1540
Fax Number	:	501-663-9665

Provider Business Practice Location Address
First Line	:	1100 NORTH UNIVERSITY
Second Line	:	SUITE 125
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-6356
Country	:	US
Telephone Number	:	501-664-1540
Fax Number	:	501-663-9665

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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