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General NPI Number Information
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NPI Number | 1770722407
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Entity Type | Organization
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Legal Business Name | SUBURBAN HOME PHYSICIANS,LLC
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 830 E. HIGGINS RD. SUITE 113A
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4768
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Country | US
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Telephone | 224-653-9000
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Fax | 224-653-8459
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Provider Business Mailing Address
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Address Line | 830 E. HIGGINS RD. SUITE 113A
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4768
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Country | US
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Telephone | 224-653-9000
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Fax | 224-653-8459
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY E GUMILA
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Credential |
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Telephone | 224-653-9000
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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 | 036-112261
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-115260
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License Number State | IL
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