Healthcare Provider Details

I. General information

NPI: 1467440479
Provider Name (Legal Business Name): NARCISA SURUCCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/29/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REVERE DR STE 200
NORTHBROOK IL
60062-8000
US

IV. Provider business mailing address

5 REVERE DR STE 200
NORTHBROOK IL
60062-8000
US

V. Phone/Fax

Practice location:
  • Phone: 773-316-3992
  • Fax: 618-710-1100
Mailing address:
  • Phone: 773-316-3992
  • Fax: 618-710-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036095365
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: