MEDICARE: SUSAN LOUISE DONAHUE D.O.

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	02898	IA

Other Identifiers

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

General Provider Information

NPI Number	:	1891797445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LOUISE DONAHUE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50302-0424
Country	:	US
Telephone Number	:	515-875-9925
Fax Number	:	515-875-9923

Provider Business Practice Location Address
First Line	:	710 COMMON PL STE 700
Second Line	:
City	:	ADEL
State	:	IA
Zip	:	50003-8044
Country	:	US
Telephone Number	:	515-875-9760
Fax Number	:	515-875-9761

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/29/2023

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