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General NPI Number Information
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NPI Number | 1104815018
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES SC
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 3004 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60657-3012
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Country | US
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Telephone | 773-871-4600
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Fax | 773-871-2900
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Provider Business Mailing Address
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Address Line | 222 E DUNDEE RD GASTROENTEROLOGY & ASSOCIATES SC
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City | WHEELING
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State | IL
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Zip | 60090-3009
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Country | US
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Telephone | 847-520-0235
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Fax | 847-520-0390
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRANK J KONICEK
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Credential | MD
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Telephone | 773-871-4600
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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 |
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License Number State |
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