Individual
SURESH C HATHIWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
CALIFORNIA AVE 15TH STREET, DEPT OF MEDICINE, CHICAGO, IL 60608-1797
(773) 257-6552
(773) 257-6027
Mailing address
1214 N KENILWORTH AVE, OAK PARK, IL 60302-1237
(708) 383-6996
(773) 257-6027
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616108
BCBS
IL
01
—
C30486
RR MEDICARE GROUP
IL
Enumeration date
07/05/2005
Last updated
09/06/2007
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