MEDICARE: SUSAN J. ERLENBORN 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
1	207R00000X	Internal Medicine Physician	036-083283	IL

General Provider Information

NPI Number	:	1265524656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J. ERLENBORN M.D.

Provider Business Mailing Address
First Line	:	3860 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2460
Country	:	US
Telephone Number	:	872-588-3000
Fax Number	:	872-588-3131

Provider Business Practice Location Address
First Line	:	3219 W. CARROLL AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2031
Country	:	US
Telephone Number	:	872-588-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	03/12/2015

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