Provider Demographics
NPI:1154398311
Name:HUENEFELD, SUZETTE LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:LYNN
Last Name:HUENEFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27511 HOLIDAY LANE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551
Mailing Address - Country:US
Mailing Address - Phone:419-872-0242
Mailing Address - Fax:419-872-1238
Practice Address - Street 1:27511 HOLIDAY LANE
Practice Address - Street 2:SUITE #101
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-872-0242
Practice Address - Fax:419-872-1238
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35067770H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2051363Medicaid
OH2051363Medicaid
G65558Medicare UPIN