Healthcare Provider Details

I. General information

NPI: 1174522171
Provider Name (Legal Business Name): SUSAN CHUA APOLINARIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SUSAN HAW CHUA-APOLINARIO M.D.

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST SUITE 105
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

4400 W 95TH ST SUITE 105
OAK LAWN IL
60453-2654
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-3417
  • Fax: 708-425-5166
Mailing address:
  • Phone: 708-425-3417
  • Fax: 708-425-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: