Healthcare Provider Details

I. General information

NPI: 1770370595
Provider Name (Legal Business Name): ALISA ANPING SUEN-WALLACH MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISA ANPING SUEN

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE M/C 5067
CHICGO IL
60637-1443
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-4503
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1611
  • Fax:
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: