Healthcare Provider Details

I. General information

NPI: 1619335700
Provider Name (Legal Business Name): PARAGON CLINICAL MIDWEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 VIRGINIA ST
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

PO BOX 2477
SHELTON CT
06484-1477
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax:
Mailing address:
  • Phone: 630-506-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARYBETH SUTKOWSKI
Title or Position: CHIEF MEDICAL OFFICER/PRINCIPAL
Credential: M.D
Phone: 630-832-1775