Provider Demographics
NPI:1689951584
Name:SUAREZ, MARTHA ERIKA (LMT)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ERIKA
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-3770
Mailing Address - Country:US
Mailing Address - Phone:773-206-3457
Mailing Address - Fax:
Practice Address - Street 1:1574 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3770
Practice Address - Country:US
Practice Address - Phone:773-206-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.013406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist