Provider Demographics
NPI:1992737399
Name:HADDOW, SUSAN SADICK (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SADICK
Last Name:HADDOW
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 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:
Practice Address - Street 1:2810 NICOLLET AVE
Practice Address - Street 2:WHITTIER CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4708
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN208593300Medicaid
MN01-16129OtherMEDICA CHOICE & PRIMARY
MN1017483OtherPREFERRRED ONE
MN27B86HAOtherBCBS
MN110873OtherUCARE
MN849245OtherARAZ
MNHP18237OtherHEALTHPARTNERS
MNHP18237OtherHEALTHPARTNERS
MN080011845Medicare ID - Type UnspecifiedMEDICARE