Provider Demographics
NPI:1306825930
Name:VIERLING, SUSAN G (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:VIERLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:630-424-9877
Practice Address - Fax:630-424-9878
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091886207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK1444OtherMEDICARE PROVIDER NUMBER
IL036091886Medicaid
IL0031600193OtherBLUE SHIELD
ILP00251102OtherRAILROAD MEDICARE
ILP00251102OtherRAILROAD MEDICARE