Provider Demographics
NPI:1043105687
Name:ASADULLAH, SUHA
Entity type:Individual
Prefix:
First Name:SUHA
Middle Name:
Last Name:ASADULLAH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13181 W HUNT MASTER LN
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8168
Mailing Address - Country:US
Mailing Address - Phone:630-297-9397
Mailing Address - Fax:
Practice Address - Street 1:135 N OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3860
Practice Address - Country:US
Practice Address - Phone:708-245-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125086571390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program