MEDICARE: DR. SUSAN M NEDZA 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	207P00000X	Emergency Medicine Physician	036-071513	IL

General Provider Information

NPI Number	:	1275536419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M NEDZA M.D.

Provider Business Mailing Address
First Line	:	812 S CLAY ST
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-4541
Country	:	US
Telephone Number	:	630-655-3835
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 W. BRYN MAWR AVE
Second Line	:	SUITE 800
City	:	CHICAGO
State	:	IL
Zip	:	60631
Country	:	US
Telephone Number	:	773-864-4764
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/03/2013

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