Healthcare Provider Details

I. General information

NPI: 1114139946
Provider Name (Legal Business Name): PARAGON CLINICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0833
US

IV. Provider business mailing address

1333 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0833
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax: 630-832-3078
Mailing address:
  • Phone: 630-832-1775
  • Fax: 630-832-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARYBETH E SUTKOWSKI
Title or Position: M.D. CEO/OWNER
Credential:
Phone: 630-605-4417