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General NPI Number Information
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NPI Number | 1871093047
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Entity Type | Organization
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Legal Business Name | GI PARTNERS OF ILLINOIS, LLC
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 1615 N CONVENT ST STE 1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1081
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Country | US
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Telephone | 815-602-8253
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Fax | 815-937-2063
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Provider Business Mailing Address
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Address Line | 1615 N CONVENT ST STE 1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1081
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Country | US
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Telephone | 815-602-8253
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRISTINA O'CONNOR
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Credential |
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Telephone | 815-602-8253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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