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General NPI Number Information
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NPI Number | 1700924222
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Entity Type | Organization
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Legal Business Name | ATHLETIC AND INDUSTRIAL MEDICINE
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 1985 DEKALB AVE SUITE 300
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City | SYCAMORE
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State | IL
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Zip | 60178-3107
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Country | US
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Telephone | 815-754-1122
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Fax | 815-787-3678
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Provider Business Mailing Address
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Address Line | 1985 DEKALB AVE SUITE 300
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City | SYCAMORE
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State | IL
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Zip | 60178-3107
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Country | US
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Telephone | 815-754-1122
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Fax | 815-787-3678
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Authorized Official
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Title or Position | MEMBER
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Name | MS. CYNTHIA FRANCES SUSEDIK
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Credential | D.O.
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Telephone | 815-754-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 036079869
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 036081304
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License Number State | IL
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