Organization
BUFFALO GROVE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERGEY SHUSHUNOV MD (PHYSICIAN)
(847) 243-0355
Entity
Organization
Contact information
Practice address
333 W DUNDEE RD, BUFFALO GROVE, IL 60089-3545
(847) 243-0355
Mailing address
333 W DUNDEE RD, BUFFALO GROVE, IL 60089-3545
(847) 243-0355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070073
—
IL
Enumeration date
03/20/2019
Last updated
03/20/2019
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