Healthcare Provider Details

I. General information

NPI: 1376656835
Provider Name (Legal Business Name): SUBURBAN NEONATAL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GARFIELD AVE
LIBERTYVILLE IL
60048-3141
US

IV. Provider business mailing address

PO BOX 2475
NORTHBROOK IL
60065-2475
US

V. Phone/Fax

Practice location:
  • Phone: 773-537-0020
  • Fax: 773-537-0030
Mailing address:
  • Phone: 773-537-0020
  • Fax: 773-537-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SYD FOREMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 773-537-0020