Healthcare Provider Details

I. General information

NPI: 1942207907
Provider Name (Legal Business Name): GASTROINTESTINAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RANDALL RD SUITE 308
GENEVA IL
60134-4209
US

IV. Provider business mailing address

302 RANDALL RD SUITE 308
GENEVA IL
60134-4209
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-7388
  • Fax: 630-208-4818
Mailing address:
  • Phone: 630-208-7388
  • Fax: 630-208-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0055909-1
License Number StateIL

VIII. Authorized Official

Name: DR. CARLOS A RODRIGUEZ
Title or Position: MEMBER
Credential: M.D.
Phone: 630-208-7388