Healthcare Provider Details

I. General information

NPI: 1033715354
Provider Name (Legal Business Name): SUSAN TAKACS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE STE 950
CHICAGO IL
60611-6659
US

IV. Provider business mailing address

737 N MICHIGAN AVE STE 950
CHICAGO IL
60611-6659
US

V. Phone/Fax

Practice location:
  • Phone: 312-751-7515
  • Fax: 312-751-1208
Mailing address:
  • Phone: 312-751-7515
  • Fax: 312-751-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number041249572
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: