Shushunov, Sergey

Shushunov, Sergey is an individual health care provider with primary practice located at 135 W Station St , Saint Anne IL 60964-7251. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine is his primary health care specialty. Shushunov, Sergey can be contacted via phone (815) 427-1324.

Contact Information

Primary practice address
135 W Station St Saint Anne IL 60964-7251
Phone: (815) 427-1324
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036070073 Illinois
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X 036070073 Illinois

Profile Details

NPI number 1588632681
LBN Legal business name Shushunov, Sergey
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Aug 22nd, 2023 - about last year

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 1588632681 NPPES
Illinois Other 07215036 BCBS
Illinois Other IL0104 BCBS
Illinois MEDICAID 036070073 BCBS

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