Healthcare Provider Details

I. General information

NPI: 1871560169
Provider Name (Legal Business Name): SUMAN KANT SETIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W 95TH ST #3
EVERGREEN PARK IL
60805-1922
US

IV. Provider business mailing address

8940 GOLDEN OAK CT
HICKORY HILLS IL
60457-3202
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-3242
  • Fax: 708-423-2856
Mailing address:
  • Phone: 708-237-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036091885
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: