Basic Information
| Provider Information | |||||||||
| NPI: | 1306823232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBRECHT | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | ALICE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 646 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SUTTONS BAY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496829601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522152387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1105 SIXTH ST | ||||||||
| Address2: | MUNSON MEDICAL CENTER | ||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496842386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319355000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1929528 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | OD029AL | 01 | MN | BCBS OF MN | OTHER | 554095000 | 05 | MN | MEDICAID | 1579489 | 01 | MN | MEDICA | OTHER |