MEDICARE: SUSAN MARIE ARCENEAUX MD INC

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
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1225708530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN MARIE ARCENEAUX MD INC

Provider Business Mailing Address
First Line	:	24498 NOBOTTOM RD
Second Line	:
City	:	OLMSTED TWP
State	:	OH
Zip	:	44138-1538
Country	:	US
Telephone Number	:	216-440-6759
Fax Number	:	330-752-4776

Provider Business Practice Location Address
First Line	:	597 LAKE RD
Second Line	:
City	:	CHIPPEWA LAKE
State	:	OH
Zip	:	44215-9665
Country	:	US
Telephone Number	:	330-760-4776
Fax Number	:	330-725-4774

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSAN MARIE ARCENEAUX
Credential	:	MD
Telephone Number	:	216-440-6759

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	06/16/2022

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