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General NPI Number Information
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NPI Number | 1386914075
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Entity Type | Individual
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Provider Name | IBADETE SULEJMANI PA
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Gender | Female
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST STE 1900
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City | CHICAGO
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State | IL
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Zip | 60611-2986
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Country | US
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Telephone | 312-695-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 676 N SAINT CLAIR ST SUITE 1900
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City | CHICAGO
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State | IL
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Zip | 60611-4395
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Country | US
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Telephone | 347-524-7329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.006239
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License Number State | IL
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