Provider Demographics
NPI:1063462885
Name:VOLARICH, SUE JANE (DO)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:JANE
Last Name:VOLARICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1853
Mailing Address - Country:US
Mailing Address - Phone:097-404-2723
Mailing Address - Fax:
Practice Address - Street 1:611 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5327
Practice Address - Country:US
Practice Address - Phone:217-544-2149
Practice Address - Fax:217-544-9553
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360903592085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00307171OtherRR MEDICARE
ILP00324250OtherRR MEDICARE
ILH42956Medicare UPIN
ILP00307171OtherRR MEDICARE
ILK27719Medicare PIN