Provider Demographics
NPI:1215974795
Name:SUSTER, SAUL M (MD)
Entity type:Individual
Prefix:DR
First Name:SAUL
Middle Name:M
Last Name:SUSTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:262-784-6907
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT. OF PATHOLOGY, DYNACARE LAB BLDG., ROOM 226
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6968
Practice Address - Fax:414-805-6938
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-5578-S174400000X
WI50728207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1215974795Medicaid
WI1215974795Medicaid
WI103573601Medicare PIN