Provider Demographics
NPI:1285715136
Name:HAIDO, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:HAIDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:STE 620
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3664
Mailing Address - Country:US
Mailing Address - Phone:773-275-8200
Mailing Address - Fax:773-275-8555
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE # 211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-275-8200
Practice Address - Fax:773-275-8555
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-089980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364399316OtherTAX ID COMM PROV #
IL036089980Medicaid
ILG14537Medicare UPIN
IL364399316OtherTAX ID COMM PROV #