Healthcare Provider Details

I. General information

NPI: 1225708530
Provider Name (Legal Business Name): SUSAN MARIE ARCENEAUX MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 LAKE RD
CHIPPEWA LAKE OH
44215-9665
US

IV. Provider business mailing address

24498 NOBOTTOM RD
OLMSTED TWP OH
44138-1538
US

V. Phone/Fax

Practice location:
  • Phone: 330-760-4776
  • Fax: 330-725-4774
Mailing address:
  • Phone: 216-440-6759
  • Fax: 330-752-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN MARIE ARCENEAUX
Title or Position: PRESIDENT
Credential: MD
Phone: 216-440-6759