Healthcare Provider Details

I. General information

NPI: 1164469573
Provider Name (Legal Business Name): SOUTH SUBURBAN ARTHRITIS GROUP SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 W. LINCOLN HWY SUITE 200
OLYMPIA FIELDS IL
60461-1936
US

IV. Provider business mailing address

2555 W. LINCOLN HWY SUITE 200
OLYMPIA FIELDS IL
60461-1936
US

V. Phone/Fax

Practice location:
  • Phone: 708-481-4900
  • Fax: 708-481-9440
Mailing address:
  • Phone: 708-481-4900
  • Fax: 708-481-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036063879
License Number StateIL

VIII. Authorized Official

Name: MS. CORBY BURKMIER
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-481-4900