MEDICARE: DR. SUSAN URBATSCH 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	19886	IA

General Provider Information

NPI Number	:	1699717355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN URBATSCH MD

Provider Business Mailing Address
First Line	:	1627 7TH PL SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4705
Country	:	US
Telephone Number	:	641-423-1670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 7TH PL SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4705
Country	:	US
Telephone Number	:	641-423-1670
Fax Number	:

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	03/20/2013

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