# SUSAN FEDINEC, D.O. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215007505
- **Authorized official:** DR. SUSAN MARIE FEDINEC D.O. (OWNER)
- **Authorized official phone:** (815) 676-2940

## Contact information

- **Practice address:** 24600 W 127TH ST, BLDG B SUITE 340, PLAINFIELD, IL 60585-9502
- **Practice address phone:** (815) 676-2940
- **Practice address fax:** (815) 676-2942
- **Mailing address:** 24600 W 127TH ST, SUITE 340 BLDG B, PLAINFIELD, IL 60585-9507
- **Mailing address phone:** (815) 676-2940
- **Mailing address fax:** (815) 676-2942

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036 078573 | IL | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 07/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 036 078573 | IL STATE LICENSE \# | IL |
| 01 | — | 9932303 | BLUE CROSS BLUE SHIELD ID | IL |