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NPI Code Detail

MEDICARE: DR. SUSAN E NELSON M.D.

MEDICARE: DR. SUSAN E NELSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036076434IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144208612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN E NELSON M.D.
Provider Business Mailing Address
First Line : 15 S MCHENRY RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-6705
Country : US
Telephone Number : 847-618-0351
Fax Number : 847-618-0766
Provider Business Practice Location Address
First Line : 15 S MCHENRY RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-6705
Country : US
Telephone Number : 847-618-0351
Fax Number : 847-618-0766
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 10/05/2021

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