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General NPI Number Information
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NPI Number | 1629307269
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Entity Type | Organization
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Legal Business Name | SUSAN E. PEARLSON, M.D., P.C.
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 645 N MICHIGAN AVE SUITE 803
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City | CHICAGO
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State | IL
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Zip | 60611-2826
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Country | US
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Telephone | 773-531-3427
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Fax |
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Provider Business Mailing Address
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Address Line | 645 N MICHIGAN AVE SUITE 803
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City | CHICAGO
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State | IL
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Zip | 60611-2826
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Country | US
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Telephone | 773-531-3427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN E. PEARLSON
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Credential | M.D.
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Telephone | 773-531-3427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036107647
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License Number State | IL
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