Provider Demographics
NPI:1871549931
Name:SZELESTEY, SUSANNA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:
Last Name:SZELESTEY
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 1:8391 COMMERCE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4489
Mailing Address - Country:US
Mailing Address - Phone:248-360-9090
Mailing Address - Fax:248-360-9093
Practice Address - Street 1:8391 COMMERCE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-360-9090
Practice Address - Fax:248-360-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043920207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4212931Medicaid
MIB48495Medicare UPIN
MIM95880003Medicare ID - Type Unspecified