Provider Demographics
NPI:1154718237
Name:HUBERTY, SUZANNE JEANNE (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:JEANNE
Last Name:HUBERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:JEANNE
Other - Last Name:MCCARTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1717 SHAFFER ST STE 10
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1623
Mailing Address - Country:US
Mailing Address - Phone:269-337-6373
Mailing Address - Fax:
Practice Address - Street 1:1717 SHAFFER ST STE 10
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1623
Practice Address - Country:US
Practice Address - Phone:269-337-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015021312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry