Provider Demographics
NPI:1649244765
Name:OLIVIERI-SULO, DENISE (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:OLIVIERI-SULO
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 1:2160 S 1ST AVE
Mailing Address - Street 2:(16621 S. 107TH CRT., ORLAND PARK, IL. 60467)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-873-7350
Mailing Address - Fax:708-460-6138
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(16621 S. 107TH CRT., ORLAND PARK, IL. 60467)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-873-7350
Practice Address - Fax:708-460-6138
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36066514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36066514Medicaid
C46049Medicare UPIN
IL724390Medicare ID - Type Unspecified