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General NPI Number Information
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NPI Number | 1063602217
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Entity Type | Organization
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Legal Business Name | SUBURBAN GYNECOLOGY, LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 1301 COPPERFIELD AVENUE SUITE 113
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City | JOLIET
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State | IL
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Zip | 60432-2004
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Country | US
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Telephone | 815-727-7515
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Fax | 815-727-5147
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Provider Business Mailing Address
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Address Line | 1890 SILVER CROSS BLVD SUITE #375
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City | NEW LENOX
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State | IL
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Zip | 60451
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Country | US
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Telephone | 815-717-8727
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Fax | 815-717-8722
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Authorized Official
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Title or Position | PROVIDER
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Name | NAHLA MERHI
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Credential | MD
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Telephone | 815-685-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036107262
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-107262
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License Number State | IL
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