Healthcare Provider Details

I. General information

NPI: 1023047842
Provider Name (Legal Business Name): SUSAN MICHELE UNFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

184 CAMBRIDGE RD
DES PLAINES IL
60016-2123
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9300
  • Fax: 847-723-9566
Mailing address:
  • Phone: 847-723-9592
  • Fax: 847-723-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-060773
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: