Individual
SERGEY SHUSHUNOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 W STATION ST, SAINT ANNE, IL 60964-7251
(815) 427-1324
Mailing address
263 APPLETREE CT, BUFFALO GROVE, IL 60089-2405
(847) 962-1858
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036070073
IL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
036070073
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070073
—
IL
01
—
07215036
BCBS
IL
01
—
IL0104
JOHN DEERE
IL
Enumeration date
03/14/2006
Last updated
08/22/2023
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