Provider Demographics
NPI:1174522171
Name:APOLINARIO, SUSAN CHUA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHUA
Last Name:APOLINARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:HAW
Other - Last Name:CHUA-APOLINARIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-425-3417
Mailing Address - Fax:708-425-5166
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-425-3417
Practice Address - Fax:708-425-5166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE68226Medicare UPIN