Healthcare Provider Details

I. General information

NPI: 1114357845
Provider Name (Legal Business Name): SUBURBAN INFECTIOUS DISEASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 BANKVIEW DR
FRANKFORT IL
60423-1382
US

IV. Provider business mailing address

PO BOX 735548
CHICAGO IL
60673-5548
US

V. Phone/Fax

Practice location:
  • Phone: 708-704-6787
  • Fax: 708-827-0400
Mailing address:
  • Phone: 708-704-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036105849
License Number StateIL

VIII. Authorized Official

Name: SHAHNAZ AZAD
Title or Position: MD OWNER
Credential:
Phone: 708-704-6787