Provider Demographics
NPI:1114139946
Name:PARAGON CLINICAL LLC
Entity Type:Organization
Organization Name:PARAGON CLINICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-605-4417
Mailing Address - Street 1:1333 BURR RIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0833
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:630-832-3078
Practice Address - Street 1:1333 BURR RIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0833
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:630-832-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG0217Medicare PIN
IL215051Medicare PIN