Individual
MITCHELL SUSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 W. PARK ST., RADIOLOGY, URBANA, IL 61801
(217) 383-3270
(217) 383-4116
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036088537
IL
2085R0202X
Diagnostic Radiology Physician
36088537
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088537*3
—
IL
01
—
0533210001
DMERC
IL
Enumeration date
06/06/2006
Last updated
05/14/2014
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