Provider Demographics
NPI:1326026501
Name:STRICH, SUSAN HERDERICH (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HERDERICH
Last Name:STRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:HERDERICH
Other - Last Name:HEPKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781
Mailing Address - Country:US
Mailing Address - Phone:906-643-8585
Mailing Address - Fax:906-643-9036
Practice Address - Street 1:1140 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781
Practice Address - Country:US
Practice Address - Phone:906-643-8585
Practice Address - Fax:906-643-9036
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057631207R00000X
MI057631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G71004OtherRHC BLUE CROSS
MI103240440Medicaid
MI3240440Medicaid
MI103240440Medicaid
MI0G71004OtherRHC BLUE CROSS
MIF69613Medicare UPIN
F69613Medicare UPIN