MEDICARE: DR. SUZIE E SCHUDER 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
1	2084P0802X	Addiction Psychiatry Physician	G 82171	CA

General Provider Information

NPI Number	:	1497830681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZIE E SCHUDER M.D.

Provider Business Mailing Address
First Line	:	901 DOVER DR
Second Line	:	SUITE 204
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-722-9884
Fax Number	:	949-722-9885

Provider Business Practice Location Address
First Line	:	901 DOVER DR
Second Line	:	SUITE 204
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-722-9884
Fax Number	:	949-722-9885

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/08/2013

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