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General NPI Number Information
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NPI Number | 1184602880
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Entity Type | Organization
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Legal Business Name | DR. SUSAN RIFE FAMILY MEDICINE SC
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 10755 W 163 PLACE
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City | ORLAND PARK
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State | IL
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Zip | 60467
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Country | US
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Telephone | 708-873-1187
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Fax | 708-873-1204
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Provider Business Mailing Address
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Address Line | 10755 W 163 PLACE
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City | ORLAND PARK
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State | IL
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Zip | 60467
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Country | US
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Telephone | 708-873-1187
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Fax | 708-873-1204
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | SUSAN BARBARA RIFE
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Credential | DO
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Telephone | 708-873-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036077841
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License Number State | IL
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