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General NPI Number Information
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NPI Number | 1871705368
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Entity Type | Organization
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Legal Business Name | PLATINUM FAMILY MEDICINE SC.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 1012 95TH ST SUITE 9
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City | NAPERVILLE
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State | IL
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Zip | 60564-5041
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Country | US
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Telephone | 630-689-4944
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Fax | 630-717-0981
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Provider Business Mailing Address
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Address Line | 1012 95TH ST SUITE 9
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City | NAPERVILLE
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State | IL
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Zip | 60564-5041
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Country | US
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Telephone | 630-689-4944
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Fax | 630-717-0981
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | CLAIRE N SUTTON
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Credential | M.D.
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Telephone | 630-689-4944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042619030
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License Number State | IL
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