Healthcare Provider Details

I. General information

NPI: 1265432496
Provider Name (Legal Business Name): SUSAN L HASEGAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ PATHOLOGY LAB
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

2300 N CHILDRENS PLZ BOX 17
CHICAGO IL
60614-3363
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4000
  • Fax:
Mailing address:
  • Phone: 773-880-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: