Provider Demographics
NPI:1306984216
Name:SANKARI, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SANKARI
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 1:6010 ROUTE 53 STE D
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3391
Mailing Address - Country:US
Mailing Address - Phone:630-778-8800
Mailing Address - Fax:630-778-8909
Practice Address - Street 1:6010 ROUTE 53 STE D
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3391
Practice Address - Country:US
Practice Address - Phone:630-778-8800
Practice Address - Fax:630-778-8909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4759304OtherCIGNA
IL5683550OtherAETNA
IL02227160OtherBCBS
IL02227160OtherBCBS