=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184837734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN D CHARLAMB M D P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 06/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 W MAPLE RD SUITE C304
-----------------------------------------------------
City | W BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-855-5540
-----------------------------------------------------
Fax | 248-855-4877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5600 W MAPLE RD SUITE C304
-----------------------------------------------------
City | W BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-855-5540
-----------------------------------------------------
Fax | 248-855-4877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN D CHARLAMB
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 248-855-5540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 4301043021
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------