DR. SUSAN M FOWELL (NPI# 1821091075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821091075 |
| Entity Type | Individual |
| Full Name | DR. SUSAN M FOWELL |
| Credential | MD |
| Practice Address |
1235 N Mulford Rd Suite 100 Rockford IL 61107-3879 |
| Practice Telephone | 8152264990 |
| Practice Fax Number | 8152269472 |
| Mailing Telephone | 8152264990 |
| Mailing Fax Number | 8152269472 |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2017-07-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 036073359 | IL | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
036073359 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036073359 | 05 | |
| IL | TAX ID# | 363734974 | 01 |
| IL | IL STATE LICENSE # | 036073359 | 01 |
| Street Address |
1235 N MULFORD RD SUITE 100 |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-3879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164875852 | Bryn Maxine Byers Krause | Nurse Practitioner | 1235 N Mulford Rd, Suite 205, Rockford, IL 61107-3879 | 2016-07-18 |
| 1306211198 | Christine Lenox | Counselor | 1235 N Mulford Rd, Suite 200, Rockford, IL 61107-3879 | 2015-12-06 |
| 1962873919 | Renviva LLC | Clinic/Center | 1235 N Mulford Rd, Rockford, IL 61107-3879 | 2015-10-16 |
| 1578971487 | Northern Illinois Trauma Regional Orthopaedics, LLC | Orthopaedic Surgery | 1235 N Mulford Rd, Suite 103, Rockford, IL 61107-3879 | 2014-07-24 |
| 1598053571 | Stephanie Jo Drake | Physical Therapy Assistant | 1235 N Mulford Rd, Rockford, IL 61107-3879 | 2011-07-12 |
| 1932437290 | Surgical Services of Illinois, Sc | Dermatology | 1235 N Mulford Rd, Ste. 205, Rockford, IL 61107-3879 | 2009-11-25 |
| 1154576221 | Tanya J. Munger | Registered Nurse | 1235 N Mulford Rd, Suite 222, Rockford, IL 61107-3879 | 2008-11-17 |
| 1376714600 | Laura Koch | Clinical Nurse Specialist | 1235 N Mulford Rd, Suite 200, Rockford, IL 61107-3879 | 2008-03-14 |
| 1669640504 | Todd D Alexander Md Sc | Neurological Surgery | 1235 N Mulford Rd, Suite 210, Rockford, IL 61107-3879 | 2008-02-13 |
| 1942483664 | Northern Illinois Retina Ltd | Ophthalmology | 1235 N Mulford Rd, Suite 100, Rockford, IL 61107-3879 | 2007-12-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275739518 | Retina Macula Specialists, P.C. | Ophthalmology | 550 E. Boughton Road Suite 120, Bilingbrook, IL 60440 | 2007-06-25 |
| 1447243407 | Irma Ahmed | Ophthalmology | 550 E. Boughton Rd, Suite 120, Bolingbrook, IL 60440 | 2005-08-25 |
| 1689666885 | Michael A Grassi | Ophthalmology | 1012 95th St Ste 9, Naperville, IL 60564-5040 | 2005-08-16 |
| 1376022426 | Marion Eye Centers Ltd. | Ophthalmology | 621 S 2nd St, Greenville, IL 62246-1744 | 2018-08-09 |
| 1790211381 | Reitna Institute of Illinois | Ophthalmology | 8780 W Golf Rd, Ste 304, Niles, IL 60714-5602 | 2017-05-03 |
| 1023472560 | Chirag Shah | Ophthalmology | 71 W 156th St Ste 400, Harvey, IL 60426-4265 | 2016-04-11 |
| 1598121113 | Grassi Retina Md Sc | Ophthalmology | 1012 95th St, Suite 9, Naperville, IL 60564-5041 | 2016-01-12 |
| 1366820441 | Omar Hassan | Ophthalmology | 1740 W Taylor St, Chicago, IL 60612-7232 | 2015-05-11 |
| 1235572173 | Ria Dirghayu Desai | Ophthalmology | 259 E Erie St Ste 1520, Chicago, IL 60611-3111 | 2013-04-10 |
| 1679836647 | Andrew W Francis | Ophthalmology | 303 W Lake St, Ste 303, Addison, IL 60101-2586 | 2012-06-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.