Healthcare Provider Details

I. General information

NPI: 1508891995
Provider Name (Legal Business Name): SUZANNE MARIE HOWARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-8602
US

IV. Provider business mailing address

801 ROSEHILL RD
JACKSON MI
49202-1762
US

V. Phone/Fax

Practice location:
  • Phone: 616-272-3533
  • Fax: 616-259-4839
Mailing address:
  • Phone: 517-212-2008
  • Fax: 517-212-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301087520
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number8843
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: