Provider Demographics
NPI:1083927321
Name:GOMEZ, SUSAN TERESE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TERESE
Last Name:GOMEZ
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:890 E HIGGINS RD
Mailing Address - Street 2:SUITE 156
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4799
Mailing Address - Country:US
Mailing Address - Phone:224-653-9000
Mailing Address - Fax:224-653-8459
Practice Address - Street 1:890 E HIGGINS RD
Practice Address - Street 2:SUITE 156
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4799
Practice Address - Country:US
Practice Address - Phone:224-653-9000
Practice Address - Fax:224-653-8459
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085.003289363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant