Healthcare Provider Details

I. General information

NPI: 1336119858
Provider Name (Legal Business Name): CHRISTOPHER L SUREK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 GREENWOOD AVE SUITE D
DEERFIELD IL
60015-2709
US

IV. Provider business mailing address

1321 GREENWOOD AVE SUITE D
DEERFIELD IL
60015-2709
US

V. Phone/Fax

Practice location:
  • Phone: 225-354-9058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number64873-21
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64873-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: