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General NPI Number Information
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NPI Number | 1619335700
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Entity Type | Organization
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Legal Business Name | PARAGON CLINICAL MIDWEST, LLC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 8380 VIRGINIA ST
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 630-832-1775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2477
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City | SHELTON
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State | CT
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Zip | 06484-1477
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Country | US
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Telephone | 630-506-1245
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER/PRINCIPAL
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Name | MARYBETH SUTKOWSKI
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Credential | M.D
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Telephone | 630-832-1775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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