Provider Demographics
NPI:1588707145
Name:DORGAI, SUSAN K (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:DORGAI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 STILLWAGON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9648
Mailing Address - Country:US
Mailing Address - Phone:989-343-1425
Mailing Address - Fax:
Practice Address - Street 1:7887 COOLEY LAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3531
Practice Address - Country:US
Practice Address - Phone:248-366-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP21710002Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
MIT88169Medicare UPIN