MEDICARE: SUSAN A NEILSEN 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	35065003	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	378646	OTHER	OH	WELLCARE
2	340714684101	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	196433	OTHER	OH	WELLCARE
5	341542312098	OTHER	OH	CARESOURCE
6	740117	OTHER	OH	BCHP
7	P00448233	OTHER	OH	RAILROAD CARE
8	000000370582	OTHER	OH	ANTHEM BC/BS
9	000000380939	OTHER	OH	ANTHEM BC/BS
10	740121	OTHER	OH	BCHP
11	P00368534	OTHER	OH	CARERR

General Provider Information

NPI Number	:	1447336946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A NEILSEN MD

Provider Business Mailing Address
First Line	:	15900 SNOW RD
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2859
Country	:	US
Telephone Number	:	216-265-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 SNOW RD
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2859
Country	:	US
Telephone Number	:	216-365-0772
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/22/2021

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Directions to “ SUSAN A NEILSEN MD” Practice Location

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