Healthcare Provider Details

I. General information

NPI: 1821095936
Provider Name (Legal Business Name): NESREEN SUWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2867 OGDEN AVE
LISLE IL
60532-1634
US

IV. Provider business mailing address

2867 OGDEN AVE
LISLE IL
60532-1634
US

V. Phone/Fax

Practice location:
  • Phone: 630-420-8080
  • Fax: 630-778-9090
Mailing address:
  • Phone: 630-420-8080
  • Fax: 630-778-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-099630
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: