Provider Demographics
NPI:1619033065
Name:SUH, GRACE K (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:K
Last Name:SUH
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 1:304 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4200
Mailing Address - Country:US
Mailing Address - Phone:630-232-0610
Mailing Address - Fax:630-232-0675
Practice Address - Street 1:304 RANDALL RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4200
Practice Address - Country:US
Practice Address - Phone:630-232-0610
Practice Address - Fax:630-232-0675
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131482207RH0003X
TXM6902207R00000X
IN1619033065207RH0003X, 207RX0202X
CT044463208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM6902OtherTEXAS MEDICAL BOARD
CT044463OtherCT PHYSICIAN LICENSE
IN201020800Medicaid
IN201020800Medicaid
CT044463OtherCT PHYSICIAN LICENSE