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Organization
V SUSARLA MDSC
Active
Organization
V SUSARLA MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VISWANATHAM SUSARLA MD (PHYSICIAN)
(847) 741-0026
Entity
Organization
Contact information
Practice address
860 SUMMIT ST, SUITE 123, ELGIN, IL 60120-5145
(847) 741-0026
Mailing address
860 SUMMIT ST, SUITE 123, ELGIN, IL 60120-5145
(847) 741-0026
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE4313
RAILROAD MEDICARE
IL
Enumeration date
12/04/2007
Last updated
12/21/2007
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