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General NPI Number Information
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NPI Number | 1114274529
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Entity Type | Individual
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Provider Name | SUSIANI INTAN MD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 2801 W KINNICKINNIC RIVER PKWY
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City | MILWAUKEE
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State | WI
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Zip | 53215-3669
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Country | US
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Telephone | 414-385-1922
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Fax | 414-385-1988
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 62449
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | 62499
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License Number State | WI
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