Fowell, Susan M

Fowell, Susan M is an sole proprietor health care provider with primary practice located at 1235 N Mulford Rd Suite 100, Rockford IL 61107-3879. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Retina Specialist. Allopathic & Osteopathic Physicians / Retina Specialist is her primary health care specialty. Fowell, Susan M can be contacted via phone (815) 226-4990.

Contact Information

Primary practice address
1235 N Mulford Rd Suite 100 Rockford IL 61107-3879
Phone: (815) 226-4990
Fax: (815) 226-9472
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 036073359 Illinois
Allopathic & Osteopathic Physicians / Retina Specialist 207WX0107X 036073359 Illinois

Profile Details

NPI number 1821091075
LBN Legal business name Fowell, Susan M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 23rd, 2005
Last updated Jul 6th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821091075 NPPES
Illinois Other 363734974 TAX ID#
Illinois MEDICAID 036073359 TAX ID#
Illinois Other 036073359 TAX ID#

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