MEDICARE: SUSAN T POLITANO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209004184	IL

General Provider Information

NPI Number	:	1285724344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN T POLITANO FNP

Provider Business Mailing Address
First Line	:	3700 W 103RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3105
Country	:	US
Telephone Number	:	773-298-3712
Fax Number	:	773-298-3906

Provider Business Practice Location Address
First Line	:	3700 W 103RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3105
Country	:	US
Telephone Number	:	773-298-3712
Fax Number	:	773-298-3906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/17/2009

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