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General NPI Number Information
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NPI Number | 1629099569
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Entity Type | Organization
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Legal Business Name | LAURENCE M SUSINI MD PC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 155 CALLE PORTAL STE 100
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2900
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Country | US
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Telephone | 520-458-6088
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Fax | 520-458-3983
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Provider Business Mailing Address
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Address Line | 155 CALLE PORTAL STE 100
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2900
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Country | US
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Telephone | 520-458-6088
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Fax | 520-458-3983
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Authorized Official
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Title or Position | CONTRACTS
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Name | SANDY KAPLAN
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Credential |
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Telephone | 520-458-6331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17611
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License Number State | AZ
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