Healthcare Provider Details

I. General information

NPI: 1598790743
Provider Name (Legal Business Name): SUSAN MIKAELIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 SCARBOROUGH DR STE 100
COLORADO SPRINGS CO
80920-7583
US

IV. Provider business mailing address

9348 GRAND CORDERA PKWY STE 160
COLORADO SPRINGS CO
80924-7023
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-3344
  • Fax: 719-632-6118
Mailing address:
  • Phone: 719-355-1585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number228619
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0049649
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0049649
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: