Healthcare Provider Details

I. General information

NPI: 1134209703
Provider Name (Legal Business Name): SUBURBAN MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 KINGERY HWY #359
WILLOWBROOK IL
60527-2248
US

IV. Provider business mailing address

6300 KINGERY HWY #359
WILLOWBROOK IL
60527-2248
US

V. Phone/Fax

Practice location:
  • Phone: 317-598-8880
  • Fax: 317-598-8899
Mailing address:
  • Phone: 317-598-8880
  • Fax: 317-598-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA STARR
Title or Position: DIRECTOR
Credential:
Phone: 317-598-8880