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NPI Code Detail

MEDICARE: DR. KIRK L SUSOTT M.D.

MEDICARE: DR. KIRK L SUSOTT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician4301039087MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003818683
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIRK L SUSOTT M.D.
Provider Business Mailing Address
First Line : 325 E H ST
Second Line : OSCAR G. JOHNSON VA MEDICAL CENTER
City : IRON MOUNTAIN
State : MI
Zip : 49801-4760
Country : US
Telephone Number : 906-774-3300
Fax Number : 906-779-3124
Provider Business Practice Location Address
First Line : 325 E H ST
Second Line : OSCAR G. JOHNSON VA MEDICAL CENTER
City : IRON MOUNTAIN
State : MI
Zip : 49801-4760
Country : US
Telephone Number : 906-774-3300
Fax Number : 906-779-3124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 12/03/2013

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