Individual
MRS. SUSAN L JOURNAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
390 OFFICE COURT, FAIRVIEW HEIGHTS, IL 62208
(618) 233-7666
(618) 233-7461
Mailing address
390 OFFICE COURT, FAIRVIEW HEIGHTS, IL 62208
(618) 233-7666
(618) 233-7461
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036117994
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117994
—
IL
01
—
537563
BCBS MISSOURI
IL
01
—
P00407830
MEDICARE RR PTAN
IL
Enumeration date
05/03/2007
Last updated
11/07/2024
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