Organization
SUSAN FEDINEC, D.O. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN MARIE FEDINEC D.O. (OWNER)
(815) 676-2940
Entity
Organization
Contact information
Practice address
24600 W 127TH ST, BLDG B SUITE 340, PLAINFIELD, IL 60585-9502
(815) 676-2940
(815) 676-2942
Mailing address
24600 W 127TH ST, SUITE 340 BLDG B, PLAINFIELD, IL 60585-9507
(815) 676-2940
(815) 676-2942
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
036 078573
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036 078573
IL STATE LICENSE #
IL
01
—
9932303
BLUE CROSS BLUE SHIELD ID
IL
Enumeration date
11/08/2006
Last updated
07/29/2008
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