Healthcare Provider Details

I. General information

NPI: 1851674378
Provider Name (Legal Business Name): SUBURBAN BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S443 SUMMIT AVE STE 201
OAKBROOK TERRACE IL
60181-3972
US

IV. Provider business mailing address

1 S 443 SUMMIT AVE SUITE # 201
OAKBROOK TERRACE IL
60181-3973
US

V. Phone/Fax

Practice location:
  • Phone: 331-643-0559
  • Fax: 630-613-9865
Mailing address:
  • Phone: 630-613-9800
  • Fax: 630-613-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036121444
License Number StateIL

VIII. Authorized Official

Name: DR. MAZAR GOLEWALE
Title or Position: MANAGER
Credential: MD
Phone: 331-643-0559