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General NPI Number Information
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NPI Number | 1417383027
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Entity Type | Organization
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Legal Business Name | SUBURBAN INTERNISTS LLC
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 6300 159TH ST STE C
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City | OAK FOREST
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State | IL
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Zip | 60452-2779
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Country | US
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Telephone | 708-535-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 159TH ST STE C
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City | OAK FOREST
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State | IL
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Zip | 60452-2779
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Country | US
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Telephone | 708-535-3300
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. NAVNEESH SHARMA
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Credential | MD
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Telephone | 515-554-2633
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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 | 036131617
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License Number State | IL
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