Provider Demographics
NPI:1780620781
Name:SUACILLO, GLENN FRANCIS (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:FRANCIS
Last Name:SUACILLO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2065 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8160
Mailing Address - Country:US
Mailing Address - Phone:630-784-9893
Mailing Address - Fax:630-784-9893
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1222
Practice Address - Country:US
Practice Address - Phone:630-933-2600
Practice Address - Fax:630-922-1234
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG74867Medicare UPIN