MEDICARE: SUZANNE R GENYK MPH, RD

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	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	86089300	MI

General Provider Information

NPI Number	:	1699314302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE R GENYK MPH, RD

Provider Business Mailing Address
First Line	:	2762 PAGE AVE
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6914
Country	:	US
Telephone Number	:	734-255-1857
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 S MAIN ST # 457
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6938
Country	:	US
Telephone Number	:	734-255-1857
Fax Number	:

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

Provider Enumeration Date	:	12/27/2019
Last Update Date	:	03/09/2026

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