Healthcare Provider Details

I. General information

NPI: 1538173240
Provider Name (Legal Business Name): SUSAN K KURTENBACH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2025
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 N ASHLAND AVE
CHICAGO IL
60613-2593
US

IV. Provider business mailing address

1023 LYMAN AVE
OAK PARK IL
60304-2225
US

V. Phone/Fax

Practice location:
  • Phone: 773-404-0447
  • Fax: 773-404-2484
Mailing address:
  • Phone: 708-217-7567
  • Fax: 773-521-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309-000686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: