Provider Demographics
NPI:1396751350
Name:KEESHIN, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KEESHIN
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 1:900 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4012
Mailing Address - Country:US
Mailing Address - Phone:847-510-5620
Mailing Address - Fax:847-412-6440
Practice Address - Street 1:900 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4012
Practice Address - Country:US
Practice Address - Phone:847-510-5620
Practice Address - Fax:847-412-6440
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090213208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL250012120OtherRAILROAD MEDICARE
IL036090213Medicaid
IL250012119OtherRAILROAD MEDICARE
IL250012120OtherRAILROAD MEDICARE
IL250012119OtherRAILROAD MEDICARE
IL036090213Medicaid
G13867Medicare UPIN