Provider Demographics
NPI:1316915085
Name:ARCENEAUX, SUSAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:ARCENEAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24498 NOBOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1538
Mailing Address - Country:US
Mailing Address - Phone:216-440-6759
Mailing Address - Fax:330-725-0054
Practice Address - Street 1:597 LAKE RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA LAKE
Practice Address - State:OH
Practice Address - Zip Code:44215-9665
Practice Address - Country:US
Practice Address - Phone:330-760-4776
Practice Address - Fax:330-725-0054
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350631432081P2900X
OH35-063143208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903080Medicaid
OHF 51808Medicare UPIN
OHAR0734504Medicare ID - Type Unspecified