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General NPI Number Information
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NPI Number | 1114205176
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Entity Type | Organization
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Legal Business Name | MIDWEST GI AND HEPATOLOGY, LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 610 S MAPLE AVE SUITE 2600
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City | OAK PARK
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State | IL
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Zip | 60304-1091
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Country | US
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Telephone | 708-290-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 401 E ONTARIO ST APT 2909
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City | CHICAGO
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State | IL
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Zip | 60611-3051
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Country | US
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Telephone | 630-215-3157
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SONU DHILLON
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Credential | M.D.
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Telephone | 630-215-3157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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