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General NPI Number Information
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NPI Number | 1447055074
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Entity Type | Organization
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Legal Business Name | MICHAEL X SU MD PC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 489 DEVON PARK DR STE 306
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City | WAYNE
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State | PA
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Zip | 19087-1809
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Country | US
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Telephone | 610-663-4109
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Fax |
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Provider Business Mailing Address
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Address Line | 466 RIDGE LN
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City | SPRINGFIELD
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State | PA
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Zip | 19064-1119
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Country | US
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Telephone | 318-918-0525
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL X SU
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Credential | MD, MA
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Telephone | 318-918-0525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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