Provider Demographics
NPI:1487818217
Name:SUH, SARA J (LAC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:J
Last Name:SUH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 N CLARK ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5266
Mailing Address - Country:US
Mailing Address - Phone:847-530-3021
Mailing Address - Fax:
Practice Address - Street 1:2841 N CLARK ST APT 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5266
Practice Address - Country:US
Practice Address - Phone:847-530-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000789171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist