Susan M Vitalis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

31744 Issued in MN

Practice address

737 Broadway N
Fargo, ND 58122-0001

Phone

(701) 234-4811

Fax

(701) 234-6979

NPI assigned

Jul 22, 2006

Last updated

Dec 27, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198713600000",
    "number": "1669493904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 3RD ST SW",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565731108",
            "telephone_number": "218-347-1200",
            "fax_number": "218-346-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581220001",
            "telephone_number": "701-234-4811",
            "fax_number": "701-234-6979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITALIS",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "31744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.