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NPI Code Detail

MEDICARE: SUSAN M JACQUEZ-DEAN M.D

MEDICARE: SUSAN M JACQUEZ-DEAN 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
12084P0800XPsychiatry Physician45956-020WI

Other Identifiers

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

General Provider Information

NPI Number : 1659482339
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M JACQUEZ-DEAN M.D
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number : 920-288-4539
Provider Business Practice Location Address
First Line : 1160 KEPLER DR
Second Line : 2ND FLOOR
City : GREEN BAY
State : WI
Zip : 54311-8321
Country : US
Telephone Number : 920-288-5630
Fax Number : 920-288-5439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/01/2024

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