Provider Demographics
NPI:1124100839
Name:ASHBY, SUZANNE (DO)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ASHBY
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 1:609 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2420
Mailing Address - Country:US
Mailing Address - Phone:847-223-9494
Mailing Address - Fax:
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-933-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107655207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633008OtherBLUE SHIELD
IL036107655Medicaid
I19042Medicare UPIN