Provider Demographics
NPI:1609856046
Name:VANDENBRINK-WEBB, SUZANNE E (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:VANDENBRINK-WEBB
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 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-781-1183
Mailing Address - Fax:888-837-4893
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 3D
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-781-1183
Practice Address - Fax:888-837-4893
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4320699Medicaid
MI4320699Medicaid