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General NPI Number Information
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NPI Number | 1205907268
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Entity Type | Individual
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Provider Name | SUSAN PAULENA CORZILIUS MD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 5125 SKYLINE RD S KAISER SKYLINE MEDICAL OFFICE - FAMILY MEDICINE
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City | SALEM
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State | OR
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Zip | 97306-9427
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Country | US
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Telephone | 503-361-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 5125 SKYLINE RD S KAISER SKYLINE MEDICAL OFFICE - FAMILY MEDICINE
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City | SALEM
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State | OR
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Zip | 97306-9427
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G81829
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0069187
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD29252
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License Number State | OR
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