Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 036066939 | IL |
NPI | 1205890613 |
---|---|
Provider Name | Susan Miriam Fuchs |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 25/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036066939 | (05) | IL |
D75958 | (02) | |
F400389921 | PTAN (01) | IL |