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General NPI Number Information
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NPI Number | 1679720312
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Entity Type | Individual
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Provider Name | SUSAN J PEREZ P.A.- C
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Gender | Female
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 1244 WISCONSIN AVE
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City | RACINE
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State | WI
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Zip | 53403-1987
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Country | US
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Telephone | 262-687-2273
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Fax | 262-687-2014
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Provider Business Mailing Address
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Address Line | 400 W RIVER WOODS PKWY 3RD FLOOR
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City | GLENDALE
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State | WI
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Zip | 53212-1060
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Country | US
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Telephone | 414-465-3091
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Fax | 414-465-4842
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2295023
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License Number State | WI
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