Provider Demographics
NPI:1861412462
Name:SUCHOLEIKI, ROY (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:SUCHOLEIKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4056
Mailing Address - Fax:630-933-4057
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-933-4057
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360978412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097841Medicaid
ILP00289934OtherRR MEDICARE PTAN (INDIVIDUAL)
ILK22089OtherMEDICARE PTAN (INDIVIDUAL)
ILK22089OtherMEDICARE PTAN (INDIVIDUAL)
ILP00289934OtherRR MEDICARE PTAN (INDIVIDUAL)