Healthcare Provider Details

I. General information

NPI: 1134824410
Provider Name (Legal Business Name): SUBURBAN MEDICAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N GARY AVE
CAROL STREAM IL
60188-1834
US

IV. Provider business mailing address

200 N GARY AVE
CAROL STREAM IL
60188-1834
US

V. Phone/Fax

Practice location:
  • Phone: 630-326-8766
  • Fax: 630-326-8768
Mailing address:
  • Phone: 630-326-8766
  • Fax: 630-326-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHD MOHIUDDIN
Title or Position: PRESIDENT
Credential: MD
Phone: 630-360-2958