Provider Demographics
NPI:1528266566
Name:SUH, COURTNEY KIMI (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:KIMI
Last Name:SUH
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 1:1211 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-4046
Mailing Address - Country:US
Mailing Address - Phone:708-531-5200
Mailing Address - Fax:708-531-7915
Practice Address - Street 1:1211 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-4046
Practice Address - Country:US
Practice Address - Phone:708-531-5200
Practice Address - Fax:708-531-7915
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051006207Q00000X
IL036122014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine