Provider Demographics
NPI:1871780676
Name:KEESHIN, SUSAN WILLIAMS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WILLIAMS
Last Name:KEESHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 N YOUNG OAK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1645
Mailing Address - Country:US
Mailing Address - Phone:801-419-5214
Mailing Address - Fax:
Practice Address - Street 1:150 S 1000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1443
Practice Address - Country:US
Practice Address - Phone:801-823-1988
Practice Address - Fax:901-486-3978
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT63605381205207R00000X
UT6360538-12052080P0208X
OH35.094204207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases