Provider Demographics
NPI:1952575045
Name:SUSAN P ALBOVIAS MD
Entity Type:Organization
Organization Name:SUSAN P ALBOVIAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALBOVIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-735-6161
Mailing Address - Street 1:4425 W 63RD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5560
Mailing Address - Country:US
Mailing Address - Phone:773-735-6161
Mailing Address - Fax:773-735-5593
Practice Address - Street 1:4425 W 63RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5560
Practice Address - Country:US
Practice Address - Phone:773-735-6161
Practice Address - Fax:773-735-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049408Medicaid
IL21606759OtherBLUE CROSS BLUE SHIELD
ILC42339OtherUPIN
ILBA011857OtherDEA
IL490960Medicare PIN