Provider Demographics
NPI:1346312261
Name:ANDERSON, SUSAN S (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:ANDERSON
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 1:5225 OLD ORCHARD RD STE 27A
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1027
Mailing Address - Country:US
Mailing Address - Phone:847-975-2921
Mailing Address - Fax:847-501-2921
Practice Address - Street 1:5225 OLD ORCHARD RD STE 27A
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1027
Practice Address - Country:US
Practice Address - Phone:847-975-2921
Practice Address - Fax:847-501-2921
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360869952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001606486OtherBLUE CROSS BLUE SHIELD
IL0001606486OtherBLUE CROSS BLUE SHIELD
F68409Medicare UPIN