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1992962450

NPI Code Detail

MEDICARE: DR. HUSSAM SURADI M.D.

MEDICARE: DR. HUSSAM SURADI M.D.

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	207R00000X	Internal Medicine Physician	036-132580	IL
2	207R00000X	Internal Medicine Physician	01068701A	IN
3	207RA0002X	Adult Congenital Heart Disease Physician	036-132580	IL
4	207RC0000X	Cardiovascular Disease Physician	01068701A	IN
5	207RC0000X	Cardiovascular Disease Physician	036-132580	IL
6	207RI0011X	Interventional Cardiology Physician	01068701A	IN
7	207RI0011X	Interventional Cardiology Physician	036-132580	IL

General Provider Information

NPI Number	:	1992962450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUSSAM SURADI M.D.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 1159
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3883
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:	312-563-2564

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 1159
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3883
Country	:	US
Telephone Number	:	312-942-5020
Fax Number	:	312-563-2564

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	11/22/2024

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Directions to “ DR. HUSSAM SURADI M.D.” Practice Location

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