Provider Demographics
NPI:1316980196
Name:DEMEESTER, SUSANNE D (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:D
Last Name:DEMEESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5301 E HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:734-712-3001
Mailing Address - Fax:734-712-7388
Practice Address - Street 1:5301 E. HURON RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-712-3001
Practice Address - Fax:734-712-7388
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064396207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDO364Medicare PIN
MDI61543Medicare UPIN