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General NPI Number Information
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NPI Number | 1457358574
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Entity Type | Individual
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Provider Name | EVAN B SUAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 6720 167TH ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-2872
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Country | US
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Telephone | 708-429-1600
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Fax | 708-429-7216
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Provider Business Mailing Address
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Address Line | 6720 167TH ST UNIT 3
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City | TINLEY PARK
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State | IL
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Zip | 60477-2872
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Country | US
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Telephone | 708-429-1600
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Fax | 708-429-1600
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036088529
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License Number State | IL
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