MEDICARE: DR. SUSAN M FOWELL MD

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	207W00000X	Ophthalmology Physician	036073359	IL
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	036073359	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363734974	OTHER	IL	TAX ID#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	036073359	OTHER	IL	IL STATE LICENSE #

General Provider Information

NPI Number	:	1821091075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M FOWELL MD

Provider Business Mailing Address
First Line	:	1235 N MULFORD RD
Second Line	:	SUITE 100
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-226-4990
Fax Number	:	815-226-9472

Provider Business Practice Location Address
First Line	:	1235 N MULFORD RD
Second Line	:	SUITE 100
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-226-4990
Fax Number	:	815-226-9472

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/06/2017

Similar Medicare Providers

1326048547 — CHRISTOPHER A GREEN MD
Practice Location Address:

1235 N MULFORD RD
ROCKFORD, IL
61107-3879

Practice Phone: 815-398-7755
Practice Fax: 815-398-7762

1497755573 — SCOTT JONES PT
Practice Location Address:

1235 N MULFORD RD
ROCKFORD, IL
61107-3879

Practice Phone: 920-451-8142
Practice Fax: 920-451-8159

1295722650 — DAVID L MCCARTY MD
Practice Location Address:

1235 N MULFORD RD , STE 100
ROCKFORD, IL
61107-3879

Practice Phone: 815-484-9999
Practice Fax: 815-484-4255

1740277102 — ORTHOPEDIC ASSOCIATES OF NORTHERN ILLINOIS, LLC
Practice Location Address:

1235 N MULFORD RD , SUITE 100
ROCKFORD, IL
61107-3879

Practice Phone: 815-484-9999
Practice Fax: 815-484-4255

1578541470 — MARK VANANROOY PA
Practice Location Address:

1235 NORTH MULFORD ROAD , SUITE 222
ROCKFORD, IL
61107-3879

Practice Phone: 815-397-8400
Practice Fax: 815-229-0050

1841270717 — ANDREW I. JUN MD
Practice Location Address:

1235 N MULFORD RD , STE 205
ROCKFORD, IL
61107-3879

Practice Phone: 815-484-9900
Practice Fax: 815-487-4949

Directions to “ DR. SUSAN M FOWELL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.