Provider Demographics
NPI:1043280050
Name:MARIK, SUSAN ADAMS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ADAMS
Last Name:MARIK
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 1:305 W PORPHYRY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2000
Mailing Address - Country:US
Mailing Address - Phone:406-496-3627
Mailing Address - Fax:406-723-2496
Practice Address - Street 1:305 W PORPHYRY ST STE 200
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2000
Practice Address - Country:US
Practice Address - Phone:406-496-3627
Practice Address - Fax:406-723-2496
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21575207V00000X
MT83792207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4512373OtherAETNA
SC195790OtherMEDCOST
SCP00041395OtherRAILROAD MEDICARE
SCT57872Medicaid
NC8906392Medicaid
SCP00041395OtherRAILROAD MEDICARE
SCT57872Medicaid
NC8906392Medicaid
SCAA96076162Medicare PIN