Provider Demographics
NPI:1700282803
Name:JAHN, SUSAN R (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:JAHN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 MOMENTUM PL
Mailing Address - Street 2:#160
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-6068
Mailing Address - Country:US
Mailing Address - Phone:847-519-4701
Mailing Address - Fax:847-519-4707
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:#160
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-782-9600
Practice Address - Fax:630-782-1643
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-005057363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical