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General NPI Number Information
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NPI Number | 1851674378
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Entity Type | Organization
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Legal Business Name | SUBURBAN BEHAVIORAL HEALTH INC
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 263 BALMORAL CT
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City | GLENDALE HTS
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State | IL
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Zip | 60139-1306
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Country | US
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Telephone | 331-643-0559
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Fax |
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Provider Business Mailing Address
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Address Line | 1 S 443 SUMMIT AVE SUITE # 201
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3973
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Country | US
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Telephone | 630-613-9800
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Fax | 630-613-9865
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MAZAR GOLEWALE
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Credential | MD
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Telephone | 331-643-0559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036121444
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License Number State | IL
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