Healthcare Provider Details

I. General information

NPI: 1114954633
Provider Name (Legal Business Name): SUBURBAN GASTROENTEROLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S WASHINGTON ST SUITE 240
NAPERVILLE IL
60540-6603
US

IV. Provider business mailing address

640 S WASHINGTON ST SUITE 240
NAPERVILLE IL
60540-6603
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-6450
  • Fax: 630-527-6456
Mailing address:
  • Phone: 630-527-6450
  • Fax: 630-527-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DINESH JAIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-527-6450