| Doctor Name: | DR. SUSAN LYNN KAPUSTKA |
| NPI Number: | 1184982530 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 016003622 |
| Business Practice Address: | 9711 S Muirfield Dr Village Of Lakewood, IL - 600143316 |
| Business Phone Number: | 8154558090 |
| Business Fax Number: | |
| Mailing Address: | 9711 S Muirfield Dr, VILLAGE OF LAKEWOOD |
| State: | IL |
| Postal Code: | 600143316 |
| Phone Number: | 8154558090 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2012 |
| NPI Last Update Date: | 04/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 016003622 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |