Organization
EBS PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN B SUAN MD (OWNER / PHYSICIAN)
(708) 429-1600
Entity
Organization
Contact information
Practice address
6720 167TH ST, TINLEY PARK, IL 60477-2872
(708) 429-1600
Mailing address
PO BOX 967, TINLEY PARK, IL 60477-0967
(708) 532-6029
(708) 532-6095
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001633131
BCBS PROVIDER #
IL
Enumeration date
05/23/2006
Last updated
01/23/2009
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