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General NPI Number Information
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NPI Number | 1124252770
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Entity Type | Individual
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Provider Name | SUZANNE MICHELLE AVILA D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 205 E PALMER RD
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2281
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Country | US
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Telephone | 937-404-9221
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Fax | 937-404-9917
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Provider Business Mailing Address
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Address Line | 2160 EWING CRAWFIS CIR
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-9042
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Country | US
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Telephone |
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 34.015408
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | DO-04568
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License Number State | IA
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