MEDICARE: DR. SUSAN IL IORIO MD

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	207N00000X	Dermatology Physician	34868	AZ

General Provider Information

NPI Number	:	1538238373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN IL IORIO MD

Provider Business Mailing Address
First Line	:	14725 W MOUNTAIN VIEW BLVD STE 103
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2704
Country	:	US
Telephone Number	:	623-243-9077
Fax Number	:	623-544-8665

Provider Business Practice Location Address
First Line	:	14725 W MOUNTAIN VIEW BLVD STE 103
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2704
Country	:	US
Telephone Number	:	623-243-9077
Fax Number	:	623-544-8665

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/20/2022

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