MEDICARE: ALLAN B SUTOW 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	207R00000X	Internal Medicine Physician	3648363	IL

General Provider Information

NPI Number	:	1568597441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN B SUTOW MD

Provider Business Mailing Address
First Line	:	5747 W DEMPSTER
Second Line	:	SUITE #400
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3056
Country	:	US
Telephone Number	:	847-663-9820
Fax Number	:	847-663-9813

Provider Business Practice Location Address
First Line	:	5747 W DEMPSTER
Second Line	:	SUITE 400
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3056
Country	:	US
Telephone Number	:	847-663-9820
Fax Number	:	847-663-9813

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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