Healthcare Provider Details

I. General information

NPI: 1912011222
Provider Name (Legal Business Name): SUSAN D FLAGEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN D BURN DO

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 COMMERCE PKWY
NORTH PORT FL
34289-9356
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 941-429-3545
  • Fax: 941-429-3546
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3757
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number381
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS 10992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: