Healthcare Provider Details

I. General information

NPI: 1497731400
Provider Name (Legal Business Name): SUSAN M DORENBUSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3183 N NATIONAL RD
COLUMBUS IN
47201-3164
US

IV. Provider business mailing address

PO BOX 775383
CHICAGO IL
60677-5383
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-1581
  • Fax: 812-376-4028
Mailing address:
  • Phone: 812-375-3000
  • Fax: 812-375-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01039024
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: