Provider Demographics
NPI:1215940259
Name:SUSAN J W ACUNA MD SC
Entity type:Organization
Organization Name:SUSAN J W ACUNA MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-285-1530
Mailing Address - Street 1:1400 LINCOLN HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3580
Mailing Address - Country:US
Mailing Address - Phone:630-377-8500
Mailing Address - Fax:630-377-8501
Practice Address - Street 1:1400 LINCOLN HWY
Practice Address - Street 2:SUITE E
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3580
Practice Address - Country:US
Practice Address - Phone:630-377-8500
Practice Address - Fax:630-377-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG12830Medicare UPIN