Healthcare Provider Details

I. General information

NPI: 1356035018
Provider Name (Legal Business Name): SUSAN DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 PLYMOUTH RD STE 1811
ANN ARBOR MI
48109-2700
US

IV. Provider business mailing address

35992 DOVER ST
LIVONIA MI
48150-3511
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-6831
  • Fax:
Mailing address:
  • Phone: 480-330-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301517666
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: