Provider Demographics
NPI:1285776286
Name:SHIREMAN, SUSAN GERALYN (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GERALYN
Last Name:SHIREMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4205
Mailing Address - Country:US
Mailing Address - Phone:920-921-4750
Mailing Address - Fax:
Practice Address - Street 1:17 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4205
Practice Address - Country:US
Practice Address - Phone:920-921-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI765-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU70226Medicare UPIN
WI86497Medicare ID - Type UnspecifiedMEDICARE NUMBER