Healthcare Provider Details

I. General information

NPI: 1912266768
Provider Name (Legal Business Name): SUSAN ELIZABETH TUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN ELIZABETH LEFKOW M.D.

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 311
GREENSBORO NC
27401-1210
US

IV. Provider business mailing address

2001 N GARY AVE STE 240
WHEATON IL
60187-3055
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-6161
  • Fax:
Mailing address:
  • Phone: 630-416-4501
  • Fax: 630-416-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036.137392
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number3305
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2025-03456
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.137.392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: