Healthcare Provider Details

I. General information

NPI: 1083113104
Provider Name (Legal Business Name): LUIS MIGUEL SUAREZ- FERNANDEZ I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 TORRENCE AVE
CALUMET CITY IL
60409-5430
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036175645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: