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General NPI Number Information
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NPI Number | 1740368083
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Entity Type | Organization
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Legal Business Name | SUBURBAN NEUROLOGY GROUP, LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 RANDALL RD STE 208 SUITE 208
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City | GENEVA
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State | IL
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Zip | 60134-4209
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Country | US
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Telephone | 630-208-7790
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Fax | 630-563-2814
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Provider Business Mailing Address
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Address Line | 302 RANDALL RD STE 208 SUITE 208
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City | GENEVA
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State | IL
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Zip | 60134-4209
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Country | US
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Telephone | 630-208-7790
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Fax | 630-563-2814
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Authorized Official
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Title or Position | PHYSICIAN/CO-OWNER
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Name | KISHORE SANTWANI
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Credential | D.O.
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Telephone | 630-208-7790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | IL
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