Healthcare Provider Details

I. General information

NPI: 1114205176
Provider Name (Legal Business Name): MIDWEST GI AND HEPATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE SUITE 2600
OAK PARK IL
60304-1091
US

IV. Provider business mailing address

401 E ONTARIO ST APT 2909
CHICAGO IL
60611-3051
US

V. Phone/Fax

Practice location:
  • Phone: 708-290-1010
  • Fax:
Mailing address:
  • Phone: 630-215-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SONU DHILLON
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 630-215-3157