Provider Demographics
NPI:1457640468
Name:SUZANNE GREIDER ENTERPRISES MD, PC
Entity Type:Organization
Organization Name:SUZANNE GREIDER ENTERPRISES MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-869-5480
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:STE 311 WEST TOWER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-869-5480
Mailing Address - Fax:847-869-5487
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:STE 311 WEST TOWER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-869-5480
Practice Address - Fax:847-869-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty