Provider Demographics
NPI:1912900176
Name:LEBLANG, SUZANNE DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:DENISE
Last Name:LEBLANG
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 1:3848 FAU BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-362-9191
Mailing Address - Fax:561-826-1209
Practice Address - Street 1:3848 FAU BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-362-9191
Practice Address - Fax:561-826-1209
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251225400Medicaid
FL32743Medicare ID - Type Unspecified
FL251225400Medicaid