Individual
SUSANNE TIDOW-KEBRITCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, (9608 ROBERTS RD, HICKORY HILLS, IL. 60457), MAYWOOD, IL 60153
(708) 233-5333
(708) 233-5348
Mailing address
2160 S 1ST AVE, (9608 ROBERTS RD, HICKORY HILLS, IL. 60457), MAYWOOD, IL 60153
(708) 233-5333
(708) 233-5348
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
36108445
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36108445
—
IL
Enumeration date
02/15/2006
Last updated
03/05/2010
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