Provider Demographics
NPI:1821058413
Name:BLEASDALE, SUSAN CASEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CASEY
Last Name:BLEASDALE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:808 S WOOD ST
Mailing Address - Street 2:M/C 735
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7300
Mailing Address - Country:US
Mailing Address - Phone:312-996-6732
Mailing Address - Fax:312-413-1657
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-996-8337
Practice Address - Fax:312-413-1421
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-06-11
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Provider Licenses
StateLicense IDTaxonomies
IL036.109313207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI01670Medicare UPIN