Healthcare Provider Details

I. General information

NPI: 1912915117
Provider Name (Legal Business Name): SUSAN M LEMAGIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E DAHLIA AVE SUITE J
PALMER AK
99645
US

IV. Provider business mailing address

425 E DAHLIA AVE SUITE J
PALMER AK
99645
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-8379
  • Fax:
Mailing address:
  • Phone: 907-745-8379
  • Fax: 907-745-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD1992
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: