=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376500496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN SEMAN DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2006
-----------------------------------------------------
Last Update Date | 11/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6900 ORCHARD LAKE RD SUITE 315
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-470-3916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6900 ORCHARD LAKE RD STE 204
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-470-3916
-----------------------------------------------------
Fax | 678-666-9686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | SS012179
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------