Healthcare Provider Details

I. General information

NPI: 1043655301
Provider Name (Legal Business Name): SUZAN KAVUSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date: 08/12/2020
Reactivation Date: 08/22/2020

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

1035 FINROD CT
WESTLAKE VILLAGE CA
91361-1817
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 650-799-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA127069
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA127069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: