Healthcare Provider Details

I. General information

NPI: 1366624215
Provider Name (Legal Business Name): SUSANA D'AMICO MD, FACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W NURSERY ST
BUTLER MO
64730-1840
US

IV. Provider business mailing address

2799 N WASHINGTON ST
CHILLICOTHEE MO
64601-1599
US

V. Phone/Fax

Practice location:
  • Phone: 660-200-7000
  • Fax:
Mailing address:
  • Phone: 660-214-8420
  • Fax: 660-214-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2002018371
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: