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General NPI Number Information
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NPI Number | 1023387040
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Entity Type | Organization
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Legal Business Name | SURIYA SASTRI, MDPC
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6900 S MADISON ST SUITE 102
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5510
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Country | US
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Telephone | 630-325-8684
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Fax | 630-325-2490
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Provider Business Mailing Address
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Address Line | 6900 MADISON STREET SUITE - 102
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City | WILLOWBROOK
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State | IL
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Zip | 60527
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Country | US
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Telephone | 630-325-8684
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Fax | 630-325-2490
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SURIYA V SASTRI
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Credential | M.D.
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Telephone | 630-325-8684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036068118
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License Number State | IL
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