Healthcare Provider Details

I. General information

NPI: 1689860272
Provider Name (Legal Business Name): SUBURBAN MEDICAL ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N MIDLOTHIAN RD SUITE 400
MUNDELEIN IL
60060-1654
US

IV. Provider business mailing address

560 N MIDLOTHIAN RD SUITE 400
MUNDELEIN IL
60060-1654
US

V. Phone/Fax

Practice location:
  • Phone: 847-837-8442
  • Fax: 847-837-8542
Mailing address:
  • Phone: 847-837-8442
  • Fax: 847-837-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: SUSIE LAWSON
Title or Position: OFFICE
Credential:
Phone: 847-837-8442