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General NPI Number Information
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NPI Number | 1386945319
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Entity Type | Organization
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Legal Business Name | SUBURBAN MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1802 IRVING PARK RD
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City | HANOVER PARK
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State | IL
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Zip | 60133-3254
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Country | US
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Telephone | 630-289-0440
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Fax | 630-289-0442
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Provider Business Mailing Address
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Address Line | 1802 IRVING PARK RD
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City | HANOVER PARK
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State | IL
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Zip | 60133-3254
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Country | US
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Telephone | 630-289-0440
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Fax | 630-289-0442
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Authorized Official
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Title or Position | OWNER
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Name | ANAND M THAKKAR
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Credential | MD
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Telephone | 630-289-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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