Provider Demographics
NPI:1366530941
Name:LITTLE JONES, SUSAN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:LITTLE JONES
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 1:21540 W 11 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3843
Mailing Address - Country:US
Mailing Address - Phone:248-352-2000
Mailing Address - Fax:248-352-8800
Practice Address - Street 1:21540 W 11 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3843
Practice Address - Country:US
Practice Address - Phone:248-352-2000
Practice Address - Fax:248-352-8800
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISL073954208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94463Medicare UPIN
MI0P22300001Medicare ID - Type Unspecified