Healthcare Provider Details

I. General information

NPI: 1811971765
Provider Name (Legal Business Name): SAMIR SULEIMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 W BELMONT AVE
ELMWOOD PARK IL
60707-1113
US

IV. Provider business mailing address

7617 W BELMONT AVE
ELMWOOD PARK IL
60707-1113
US

V. Phone/Fax

Practice location:
  • Phone: 708-583-1410
  • Fax: 708-453-4690
Mailing address:
  • Phone: 708-583-1410
  • Fax: 708-453-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036071782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: