Provider Demographics
NPI:1770660938
Name:NAGPAL, SUEANN (MD)
Entity Type:Individual
Prefix:
First Name:SUEANN
Middle Name:
Last Name:NAGPAL
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 1:1900 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3463
Mailing Address - Country:US
Mailing Address - Phone:815-744-7300
Mailing Address - Fax:815-744-1928
Practice Address - Street 1:211 N HAMMES AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8113
Practice Address - Country:US
Practice Address - Phone:815-744-7300
Practice Address - Fax:815-744-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C43755Medicare UPIN