Provider Demographics
NPI:1285724344
Name:POLITANO, SUSAN T (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:POLITANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3105
Mailing Address - Country:US
Mailing Address - Phone:773-298-3712
Mailing Address - Fax:773-298-3906
Practice Address - Street 1:3700 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3105
Practice Address - Country:US
Practice Address - Phone:773-298-3712
Practice Address - Fax:773-298-3906
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00843Medicare PIN
ILR00842Medicare PIN
ILS98293Medicare UPIN