Provider Demographics
NPI:1992897938
Name:WEINKLE, SUSAN HOLLOWAY (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HOLLOWAY
Last Name:WEINKLE
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 1:5601 21ST AVE W
Mailing Address - Street 2:STE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5642
Mailing Address - Country:US
Mailing Address - Phone:941-794-5432
Mailing Address - Fax:941-794-5682
Practice Address - Street 1:5601 21ST AVE W
Practice Address - Street 2:STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5642
Practice Address - Country:US
Practice Address - Phone:941-794-5432
Practice Address - Fax:941-794-5682
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45450174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070005597OtherRAILROAD MEDICARE
FLK5859OtherMEDICARE GROUP #
FLK5859OtherMEDICARE GROUP #
FL41229ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #