Healthcare Provider Details

I. General information

NPI: 1164689980
Provider Name (Legal Business Name): SUBURBAN MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD BLDG 3 SUITE # 2500
HOFFMAN ESTATES IL
60169-1019
US

IV. Provider business mailing address

PO BOX 967
TINLEY PARK IL
60477-0967
US

V. Phone/Fax

Practice location:
  • Phone: 847-226-8900
  • Fax: 224-330-1665
Mailing address:
  • Phone: 708-532-6029
  • Fax: 708-532-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036-115260
License Number StateIL

VIII. Authorized Official

Name: DR. RITESH D PATEL
Title or Position: PRESIDENT
Credential: M.D
Phone: 847-226-8900