Provider Demographics
NPI:1689860272
Name:SUBURBAN MEDICAL ASSOCIATES, S.C.
Entity type:Organization
Organization Name:SUBURBAN MEDICAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-837-8442
Mailing Address - Street 1:560 N MIDLOTHIAN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1654
Mailing Address - Country:US
Mailing Address - Phone:847-837-8442
Mailing Address - Fax:847-837-8542
Practice Address - Street 1:560 N MIDLOTHIAN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1654
Practice Address - Country:US
Practice Address - Phone:847-837-8442
Practice Address - Fax:847-837-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty