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General NPI Number Information
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NPI Number | 1063695682
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Entity Type | Organization
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Legal Business Name | SUBURBAN MEDICAL CENTER, S.C
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 380 E NORTHWEST HWY STE 200
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City | DES PLAINES
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State | IL
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Zip | 60016-2274
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Country | US
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Telephone | 847-382-6870
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Fax | 847-382-6083
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Provider Business Mailing Address
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Address Line | 1900 ARMY TRAIL RD
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City | HANOVER PARK
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State | IL
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Zip | 60133-8974
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Country | US
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Telephone | 847-995-9500
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Fax | 847-995-9501
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Authorized Official
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Title or Position | OWNER
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Name | RITESH PATEL
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Credential | MD
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Telephone | 847-995-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036056234
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License Number State | IL
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