Healthcare Provider Details

I. General information

NPI: 1710476593
Provider Name (Legal Business Name): SUSANA DELIA CUADROS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSANA DELIA UGARTE PHD

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E 93RD ST
CHICAGO IL
60617-3913
US

IV. Provider business mailing address

2301 E 93RD ST
CHICAGO IL
60617-3913
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-9898
  • Fax: 773-933-8721
Mailing address:
  • Phone: 773-731-9898
  • Fax: 773-933-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036155479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: