Healthcare Provider Details

I. General information

NPI: 1003893017
Provider Name (Legal Business Name): FAMILY HEALTH SERVICES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 GLEN FLORA AVE STE 201
WAUKEGAN IL
60085
US

IV. Provider business mailing address

935 GLEN FLORA AVE STE 201
WAUKEGAN IL
60085
US

V. Phone/Fax

Practice location:
  • Phone: 847-249-3322
  • Fax: 847-249-3381
Mailing address:
  • Phone: 847-249-3322
  • Fax: 847-249-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAMPO E SUESCUN
Title or Position: OWNER
Credential: MD
Phone: 847-249-3322