Basic Information
| Provider Information | |||||||||
| NPI: | 1962817643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NESREEN SUWAN MDSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 MIDWEST CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304208080 | ||||||||
| FaxNumber: | 6309521447 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 MIDWEST CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304208080 | ||||||||
| FaxNumber: | 6309521447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2014 | ||||||||
| LastUpdateDate: | 06/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | SUWAN | ||||||||
| AuthorizedOfficialFirstName: | NESREEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304208080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | K17636 | 01 | IL | MEDICARE | OTHER | 036099630 | 05 | IL | MEDICAID |