MEDICARE: DR. SUSAN SU-CHI PERNG MD

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	207Q00000X	Family Medicine Physician	35075284P	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1386636710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN SU-CHI PERNG MD

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44871-0378
Country	:	US
Telephone Number	:	419-609-1112
Fax Number	:	419-609-1123

Provider Business Practice Location Address
First Line	:	611 FULTON ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-2008
Country	:	US
Telephone Number	:	419-734-0699
Fax Number	:	419-734-0320

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	04/22/2013

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