Organization
SUSILA SUBRAMANIAN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSILA SUBRAMANIAN M.D. (PRESIDENT)
(847) 391-9033
Entity
Organization
Contact information
Practice address
150 N RIVER RD, SUITE 240, DES PLAINES, IL 60016-1272
(847) 391-9033
(847) 391-9177
Mailing address
150 N RIVER RD, SUITE 240, DES PLAINES, IL 60016-1272
(847) 391-9033
(847) 391-9177
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036062896
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001637265
BLUE SHIELD
IL
05
—
036062896
—
IL
Enumeration date
11/30/2007
Last updated
07/01/2008
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