Provider Demographics
NPI:1427150317
Name:HARMON, SUSAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HARMON
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 1:1026 STATE ROUTE 121
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-5362
Mailing Address - Country:US
Mailing Address - Phone:217-792-3475
Mailing Address - Fax:
Practice Address - Street 1:1026 STATE ROUTE 121
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-5362
Practice Address - Country:US
Practice Address - Phone:217-792-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine