Provider Demographics
NPI:1093108557
Name:SUSAN C APOLINARIO
Entity Type:Organization
Organization Name:SUSAN C APOLINARIO
Other - Org Name:SUSAN CHUA APOLINARIO, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHUA
Authorized Official - Last Name:APOLINARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-3417
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-425-3417
Mailing Address - Fax:708-425-5166
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-425-3417
Practice Address - Fax:708-425-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074823207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL986520Medicare PIN
ILE68226Medicare UPIN