Provider Demographics
NPI:1013063536
Name:GUDEMAN, SUZANNE (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GUDEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:301-651-5983
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL ROTA SPAIN
Practice Address - Street 2:PSC 819
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645
Practice Address - Country:US
Practice Address - Phone:314-727-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136677208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology