MEDICARE: MS. SUSAN SHRIFTER-FIALKOW

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	1041C0700X	Clinical Social Worker	149002946	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	162-0249	OTHER	IL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1780773267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN SHRIFTER-FIALKOW

Provider Business Mailing Address
First Line	:	2435 HAMPTON LN
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6942
Country	:	US
Telephone Number	:	312-245-3120
Fax Number	:	312-245-3124

Provider Business Practice Location Address
First Line	:	435 N MICHIGAN AVE
Second Line	:	SUITE 2800
City	:	CHICAGO
State	:	IL
Zip	:	60611-4066
Country	:	US
Telephone Number	:	312-245-3120
Fax Number	:	312-245-3124

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/15/2010

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