| Susan M Moore-riesbeck DO | |
|
28070 County Road 24 Elkhart IN 46517-9717 | |
| (574) 273-8053 | |
| (574) 273-8056 |
| Full Name | Susan M Moore-riesbeck DO |
|---|---|
| Speciality | Family Medicine |
| Location | 28070 County Road 24, Elkhart, Indiana |
| Authorized Official Name and Position | David Riesbeck (ACCOUNTANT) |
| Authorized Official Contact | 5749934464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan M Moore-riesbeck DO Po Box 175 Granger IN 46530-0175 Ph: (574) 273-8053 | Susan M Moore-riesbeck DO 28070 County Road 24 Elkhart IN 46517-9717 Ph: (574) 273-8053 |
| NPI Number | 1174178701 |
|---|---|
| Provider Enumeration Date | 08/09/2019 |
| Last Update Date | 11/07/2019 |
| Medicare PECOS PAC ID | 7113351909 |
|---|---|
| Medicare Enrollment ID | O20200103000650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174178701 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Primary |
| Provider Name | Susan Marie Moore Riesbeck |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1215090378 PECOS PAC ID: 2961496245 Enrollment ID: I20040409000595 |
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