Healthcare Provider Details

I. General information

NPI: 1902546013
Provider Name (Legal Business Name): SUSAN LUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

IV. Provider business mailing address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-2020
  • Fax: 414-805-4818
Mailing address:
  • Phone: 414-955-2020
  • Fax: 414-805-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number83027-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: