Provider Demographics
NPI:1780770446
Name:DALY, SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:K
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1327
Mailing Address - Country:US
Mailing Address - Phone:520-432-6481
Mailing Address - Fax:520-432-5082
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5105006207RG0100X
AZ42912207RG0100X
IN01090370A207RG0100X
IL036170692207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT51050061200001OtherVALUE CARE
UT68277OtherPUBLIC EMPLOYEES
UT51050061200001OtherHEALTHWISE
UT51050061200001OtherBLUE CROSS BLUE SHIELD
UTQM0000058317OtherALTIUS
UT000012581Medicare ID - Type Unspecified
UT51050061200001OtherHEALTHWISE
UT51050061200001OtherVALUE CARE