Provider Demographics
NPI:1699776708
Name:WOLOSON, SUSANNE K (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:K
Last Name:WOLOSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1614 W CENTRAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2490
Mailing Address - Country:US
Mailing Address - Phone:847-577-5814
Mailing Address - Fax:847-577-5914
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-577-5814
Practice Address - Fax:847-577-5914
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2021-12-17
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Provider Licenses
StateLicense IDTaxonomies
IL0360930272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG83160Medicare UPIN