=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912956962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATES IN DIGESTIVE DISEASES, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 09/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 S YORK RD SUITE 3250
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-5626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-758-8889
-----------------------------------------------------
Fax | 630-758-8705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 S YORK RD SUITE 3250
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-5626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-758-8889
-----------------------------------------------------
Fax | 630-758-8705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OWNER
-----------------------------------------------------
Name | DR. GERARD ALBERT SUBLETTE JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 630-758-8889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 036-059182
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------