Provider Demographics
NPI:1043358914
Name:SUSEDIK, CYNTHIA FRANCES (DO)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:FRANCES
Last Name:SUSEDIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7863
Mailing Address - Country:US
Mailing Address - Phone:920-830-6877
Mailing Address - Fax:920-993-5037
Practice Address - Street 1:3925 N GATEWAY DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7863
Practice Address - Country:US
Practice Address - Phone:920-830-6877
Practice Address - Fax:920-993-5037
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33577207Q00000X, 207P00000X
IL036-081304207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE71843Medicare UPIN
IL211332Medicare PIN