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General NPI Number Information
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NPI Number | 1659690022
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Entity Type | Organization
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Legal Business Name | SUBURBAN METABOLIC INSTITUTE, LLC
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 908 N ELM ST STE 309
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City | HINSDALE
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State | IL
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Zip | 60521-3625
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Country | US
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Telephone | 708-484-0621
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Fax | 708-484-0250
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Provider Business Mailing Address
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Address Line | 908 N ELM ST STE 309
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City | HINSDALE
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State | IL
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Zip | 60521-3625
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Country | US
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Telephone | 708-484-0621
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Fax | 708-484-0250
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. RYAN C. HEADLEY
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Credential | M.D.
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Telephone | 708-484-0621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036118355
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036114720
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License Number State | IL
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