Healthcare Provider Details

I. General information

NPI: 1881876803
Provider Name (Legal Business Name): SUSILA SUBRAMANIAN MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N RIVER RD SUITE 240
DES PLAINES IL
60016-1272
US

IV. Provider business mailing address

150 N RIVER RD SUITE 240
DES PLAINES IL
60016-1272
US

V. Phone/Fax

Practice location:
  • Phone: 847-391-9033
  • Fax: 847-391-9177
Mailing address:
  • Phone: 847-391-9033
  • Fax: 847-391-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036062896
License Number StateIL

VIII. Authorized Official

Name: DR. SUSILA SUBRAMANIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-391-9033