Healthcare Provider Details

I. General information

NPI: 1720244304
Provider Name (Legal Business Name): PATRICK ALEXANDER SUGRUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LUTHER LANE SUITE 1170
PARK RIDGE IL
60068
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 844-376-3876
  • Fax: 847-723-2041
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036124709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: