Provider Demographics
NPI:1700972999
Name:SPIRTOVIC, SUADA N (MD)
Entity Type:Individual
Prefix:
First Name:SUADA
Middle Name:N
Last Name:SPIRTOVIC
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 1:900 N KINGSBURY ST
Mailing Address - Street 2:STE 825
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7432
Mailing Address - Country:US
Mailing Address - Phone:312-671-5000
Mailing Address - Fax:312-337-9902
Practice Address - Street 1:40 SHUMAN BLVD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8446
Practice Address - Country:US
Practice Address - Phone:312-671-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108247207LP2900X, 207Q00000X
IL036-108247207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108247Medicaid
ILP00618465OtherMEDICARE RAILROAD
IL01638884OtherBLUE CROSS AND BLUE SHIELD
ILP00618465OtherMEDICARE RAILROAD