Provider Demographics
NPI:1699897306
Name:SU, ANDY WEI-HAO (MD)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:WEI-HAO
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E OGDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3418
Mailing Address - Country:US
Mailing Address - Phone:630-363-3470
Mailing Address - Fax:
Practice Address - Street 1:177 E BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5658
Practice Address - Country:US
Practice Address - Phone:331-221-5900
Practice Address - Fax:331-221-3857
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361174682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117468Medicaid
ILK39627Medicare PIN
ILK39628Medicare PIN
ILK39626Medicare PIN