Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036136677 | IL |
NPI | 1013063536 |
---|---|
Provider Name | Suzanne Gudeman |
First Address | North Chicago, IL 60064-3048 |
Second Address | North Chicago, IL 60064-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 01/10/2021 |