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General NPI Number Information
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NPI Number | 1386791176
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Entity Type | Individual
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Provider Name | SUSAN ALISANSKI MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 5450 YMCA RD STE 102
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City | NAPLES
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State | FL
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Zip | 34109-5944
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Country | US
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Telephone | 239-658-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 MADISON AVE W
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City | IMMOKALEE
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State | FL
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Zip | 34142-2200
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Country | US
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Telephone | 239-658-3000
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Fax | 239-596-1661
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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 | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | ME113536
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | ME113536
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME113536
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License Number State | FL
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