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General NPI Number Information
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NPI Number | 1306035720
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Entity Type | Individual
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Provider Name | VINCENT R SUSINI MD, DC, MSC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 3801 SPRING ST
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City | RACINE
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 262-687-5656
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Fax |
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Provider Business Mailing Address
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Address Line | ST LUKE'S HOSPITAL 1244 WISCONSIN AVE
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City | RACINE
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State | WI
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Zip | 53403
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Country | US
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Telephone | 262-672-7147
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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