Provider Demographics
NPI:1154375061
Name:KEARNEY, SUSAN LYNN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 CHICAGO AVENUE SOUTH
Mailing Address - Street 2:SUITE CSC-175
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-813-5940
Mailing Address - Fax:612-813-6325
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH
Practice Address - Street 2:SUITE CSC-175
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-5940
Practice Address - Fax:612-813-6325
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216985208000000X, 2080P0207X
MN489302080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics