Provider Demographics
NPI:1326128513
Name:MYERS, FAITH SUZANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:SUZANNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 127TH ST
Mailing Address - Street 2:SUITE 261
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439
Mailing Address - Country:US
Mailing Address - Phone:630-243-7683
Mailing Address - Fax:630-243-8184
Practice Address - Street 1:15900 W 127TH ST
Practice Address - Street 2:SUITE 261
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:630-243-7683
Practice Address - Fax:630-243-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336060386208000000X
IL036100053208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36100053Medicaid
IL036100053Medicaid