Healthcare Provider Details

I. General information

NPI: 1578691846
Provider Name (Legal Business Name): FMGC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LAKE ST STE. 205
ADDISON IL
60101-2586
US

IV. Provider business mailing address

7540 EXTON ST
DARIEN IL
60561-6706
US

V. Phone/Fax

Practice location:
  • Phone: 630-458-8855
  • Fax: 630-543-3943
Mailing address:
  • Phone: 630-458-8855
  • Fax: 630-543-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDF5439
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. UTPAL P. PAREKH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-458-8855