Healthcare Provider Details

I. General information

NPI: 1205890613
Provider Name (Legal Business Name): SUSAN MIRIAM FUCHS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 62
CHICAGO IL
60611
US

IV. Provider business mailing address

225 E CHICAGO AVE # 62
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6647
  • Fax: 312-227-9475
Mailing address:
  • Phone: 312-227-6647
  • Fax: 312-227-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number036066939
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: