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General NPI Number Information
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NPI Number | 1407824006
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Entity Type | Organization
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Legal Business Name | DOWNERS GROVE INTERNISTS, S.C.
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3825 HIGHLAND AVE SUITE 5B
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-963-9667
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Fax | 630-963-9936
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Provider Business Mailing Address
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Address Line | 3825 HIGHLAND AVE SUITE 5B
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-963-9667
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Fax | 630-963-9936
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | BARBARA B LOEB
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Credential | M.D.
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Telephone | 630-963-9667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | IL
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