Provider Demographics
NPI:1588650139
Name:NELSON, SUZANNE P (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:P
Last Name:NELSON
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:2551 COMPASS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8045
Practice Address - Country:US
Practice Address - Phone:847-724-7825
Practice Address - Fax:847-724-7845
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634323OtherBCBS PROVIDER ID
IL1634323OtherBCBS PROVIDER ID
ILG14089Medicare UPIN