Active NPI
Susan Anne Gannon, MT-BC
- Contractor
- Plymouth, MI
National Provider Identifier
1649418682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 08001
- Practice address
- 9357 General Dr
Plymouth, MI 48170-4662 - Phone
- (734) 454-0866
- NPI assigned
- Jan 29, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 08001 | MI | Primary |
Addresses
Primary practice location
9357 General Dr
Plymouth, MI 48170-4662
Mailing address
9211 Huron River Dr
Dexter, MI 48130-9611
Phone (734) 426-5634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08001 | MI | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233187200000",
"number": "1649418682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9211 HURON RIVER DR",
"city": "DEXTER",
"state": "MI",
"postal_code": "481309611",
"telephone_number": "734-426-5634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9357 GENERAL DR",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481704662",
"telephone_number": "734-454-0866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "SUSAN",
"middle_name": "ANNE",
"credential": "MT-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-29",
"last_updated": "2009-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MI",
"license": "08001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.