Provider Demographics
NPI:1568597441
Name:SUTOW, ALLAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
Last Name:SUTOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 W DEMPSTER
Mailing Address - Street 2:SUITE #400
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3056
Mailing Address - Country:US
Mailing Address - Phone:847-663-9820
Mailing Address - Fax:847-663-9813
Practice Address - Street 1:5747 W DEMPSTER
Practice Address - Street 2:SUITE 400
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3056
Practice Address - Country:US
Practice Address - Phone:847-663-9820
Practice Address - Fax:847-663-9813
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL3648363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12788Medicare UPIN
479020Medicare ID - Type Unspecified