Basic Information
Provider Information
NPI: 1588891329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PITT
FirstName: SUSAN
MiddleName: CLARE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481081633
CountryCode: US
TelephoneNumber: 7346475299
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481095000
CountryCode: US
TelephoneNumber: 7349365738
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/19/2009
LastUpdateDate: 08/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XEMC0000931MIY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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