Provider Demographics
NPI:1932188109
Name:SPIRES, SUSAN E (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SPIRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2560 N SHADELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1706
Mailing Address - Country:US
Mailing Address - Phone:317-275-8072
Mailing Address - Fax:317-275-8018
Practice Address - Street 1:310 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3008
Practice Address - Country:US
Practice Address - Phone:859-226-7094
Practice Address - Fax:859-226-7859
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19036207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000355696OtherBCBS
KY50003208Medicaid
KY220033057OtherTRAVELERS
KY64190366Medicaid
WV0102340-000Medicaid
OH0876084Medicaid
WV0102340-000Medicaid
0039916Medicare PIN