Provider Demographics
NPI:1962817643
Name:NESREEN SUWAN MDSC
Entity Type:Organization
Organization Name:NESREEN SUWAN MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NESREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-420-8080
Mailing Address - Street 1:505 MIDWEST CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2529
Mailing Address - Country:US
Mailing Address - Phone:630-420-8080
Mailing Address - Fax:630-952-1447
Practice Address - Street 1:505 MIDWEST CLUB PKWY
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2529
Practice Address - Country:US
Practice Address - Phone:630-420-8080
Practice Address - Fax:630-952-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17636OtherMEDICARE
IL036099630Medicaid
ILH08577Medicare UPIN