Provider Demographics
NPI:1689785040
Name:SUBRAMANIAN, SUSILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSILA
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:150 N RIVER RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1272
Mailing Address - Country:US
Mailing Address - Phone:847-391-9033
Mailing Address - Fax:847-391-9177
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-391-9033
Practice Address - Fax:847-391-9177
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-062896208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062896Medicaid
IL036062896Medicaid