Provider Demographics
NPI:1972593408
Name:HSIEH, SUPING J (MD)
Entity type:Individual
Prefix:DR
First Name:SUPING
Middle Name:J
Last Name:HSIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3221 BEACON PKWY
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7196
Mailing Address - Country:US
Mailing Address - Phone:574-309-9974
Mailing Address - Fax:574-990-0102
Practice Address - Street 1:3221 BEACON PKWY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7196
Practice Address - Country:US
Practice Address - Phone:574-309-9974
Practice Address - Fax:574-990-0102
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01037337A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100091170Medicaid
INE05312Medicare UPIN
IN146470EMedicare ID - Type Unspecified