MEDICARE: MRS. SUSAN DENISE SEARS-LECLAIR PA-C

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	363AM0700X	Medical Physician Assistant	085.002883	IL
2	363AM0700X	Medical Physician Assistant	5069-23	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F400252938	OTHER	IL	MEDICARE PTAN (INDIVIDUAL)
2	206147	OTHER	IL	MEDICARE PTAN (GROUP)

General Provider Information

NPI Number	:	1265525117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN DENISE SEARS-LECLAIR PA-C

Provider Business Mailing Address
First Line	:	2618 OLIVE ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53403-2943
Country	:	US
Telephone Number	:	630-337-1367
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 SPRING ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-687-4011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/12/2024

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