Active NPI
Mira Suseno, PHARMD
- Infectious Diseases Pharmacist
- Evanston, IL
National Provider Identifier
1487523239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Diseases Pharmacist
- License
- 051040649
- Practice address
- 2650 Ridge Ave
Evanston, IL 60201-1700 - Phone
- (847) 570-1021
- NPI assigned
- Oct 31, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infectious Diseases Pharmacist | 1835I0206X | 051040649 | IL | Primary |
Addresses
Primary practice location
2650 Ridge Ave
Evanston, IL 60201-1700
Mailing address
1014 Highland Grove CT N
Buffalo Grove, IL 60089-7021
Phone (847) 570-1021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051040649 | IL | MD | Medical license number |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761868800000",
"number": "1487523239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 HIGHLAND GROVE CT N",
"city": "BUFFALO GROVE",
"state": "IL",
"postal_code": "600897021",
"telephone_number": "847-570-1021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011700",
"telephone_number": "847-570-1021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSENO",
"first_name": "MIRA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-31",
"last_updated": "2025-10-31",
"certification_date": "2025-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "1835I0206X",
"taxonomy_group": "",
"desc": "Pharmacist, Infectious Diseases",
"state": "IL",
"license": "051040649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.