Provider Demographics
NPI:1821095936
Name:SUWAN, NESREEN (MD)
Entity Type:Individual
Prefix:
First Name:NESREEN
Middle Name:
Last Name:SUWAN
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 1:2867 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1634
Mailing Address - Country:US
Mailing Address - Phone:630-420-8080
Mailing Address - Fax:630-778-9090
Practice Address - Street 1:2867 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1634
Practice Address - Country:US
Practice Address - Phone:630-420-8080
Practice Address - Fax:630-778-9090
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.099630207L00000X
IL036-0996302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635238OtherBCBS
IL036099630Medicaid
ILH08577Medicare UPIN
ILK17636Medicare PIN
IL036099630Medicaid