Healthcare Provider Details

I. General information

NPI: 1285857805
Provider Name (Legal Business Name): GASTROENTEROLOGY CLINICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 W SULLIVAN RD SUITE A
AURORA IL
60506-1443
US

IV. Provider business mailing address

581 W SULLIVAN RD SUITE A
AURORA IL
60506-1443
US

V. Phone/Fax

Practice location:
  • Phone: 630-560-1115
  • Fax: 630-906-7200
Mailing address:
  • Phone: 630-560-1115
  • Fax: 630-906-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036085150
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMED ASIF MAHKRI
Title or Position: OWNER
Credential: MD
Phone: 630-560-1115