Healthcare Provider Details

I. General information

NPI: 1407824006
Provider Name (Legal Business Name): DOWNERS GROVE INTERNISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HIGHLAND AVE SUITE 5B
DOWNERS GROVE IL
60515-1552
US

IV. Provider business mailing address

3825 HIGHLAND AVE SUITE 5B
DOWNERS GROVE IL
60515-1552
US

V. Phone/Fax

Practice location:
  • Phone: 630-963-9667
  • Fax: 630-963-9936
Mailing address:
  • Phone: 630-963-9667
  • Fax: 630-963-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: BARBARA B LOEB
Title or Position: OWNER/DOCTOR
Credential: M.D.
Phone: 630-963-9667