| Robert J Susin Pc | |
|
521 S La Grange Rd Suite 209 La Grange IL 60525-6700 | |
| (708) 822-7437 | |
| Not Available |
| Full Name | Robert J Susin Pc |
|---|---|
| Speciality | Social Worker |
| Location | 521 S La Grange Rd, La Grange, Illinois |
| Authorized Official Name and Position | Robert J Susin (LCSW) |
| Authorized Official Contact | 7088227437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert J Susin Pc 521 S La Grange Rd Ste 209 La Grange IL 60525-6700 Ph: (702) 822-7437 | Robert J Susin Pc 521 S La Grange Rd Suite 209 La Grange IL 60525-6700 Ph: (708) 822-7437 |
| NPI Number | 1922385616 |
|---|---|
| Provider Enumeration Date | 11/08/2011 |
| Last Update Date | 11/08/2011 |
| Medicare PECOS PAC ID | 6507023512 |
|---|---|
| Medicare Enrollment ID | O20120202000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922385616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149005102 (Illinois) | Primary |
| Provider Name | Robert J Susin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700864956 PECOS PAC ID: 2860659885 Enrollment ID: I20120208000841 |
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