Provider Demographics
NPI:1841275377
Name:ASCH, SUSAN MCCLELLAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MCCLELLAN
Last Name:ASCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34 NORTH OAKS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 NORTH OAKS RD
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-6325
Practice Address - Country:US
Practice Address - Phone:612-414-7800
Practice Address - Fax:651-275-3325
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33053207NP0225X
MN31241208000000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31793300Medicaid
MN974785100Medicaid
WI31793300Medicaid
MN370002987Medicare PIN
WI000556150Medicare PIN