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General NPI Number Information
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NPI Number | 1811995566
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Entity Type | Individual
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Provider Name | SUZANNE E ALT DO
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Gender | Female
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 4230 LINCOLNSHIRE DR STE G
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2189
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Country | US
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Telephone | 618-244-6770
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Fax | 618-244-6772
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Provider Business Mailing Address
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Address Line | 1715 W WORLEY ST STE B
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City | COLUMBIA
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State | MO
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Zip | 65203-1015
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Country | US
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Telephone | 660-341-3877
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Fax | 573-875-4879
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | R9G62
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R9G62
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License Number State | MO
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