Provider Demographics
NPI:1912963919
Name:ACADEMIC ENDOCRINE METABOLISM & NUTRITION
Entity Type:Organization
Organization Name:ACADEMIC ENDOCRINE METABOLISM & NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAESMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-416-4501
Mailing Address - Street 1:120 SPALDING DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6508
Mailing Address - Country:US
Mailing Address - Phone:630-416-4501
Mailing Address - Fax:630-416-4504
Practice Address - Street 1:120 SPALDING DR
Practice Address - Street 2:SUITE 401
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6508
Practice Address - Country:US
Practice Address - Phone:630-416-4501
Practice Address - Fax:630-416-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617401207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336075844OtherCS LICENSE #
IL036108885OtherILLINOIS PROFESSIONAL LIC
IL036108885OtherILLINOIS PROFESSIONAL LIC