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General NPI Number Information
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NPI Number | 1932291101
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Entity Type | Organization
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Legal Business Name | ELGIN GASTROENTEROLOGY SC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 745 FLETCHER DR STE 202
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City | ELGIN
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State | IL
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Zip | 60123-4747
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Country | US
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Telephone | 847-888-1300
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Fax | 847-888-1341
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Provider Business Mailing Address
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Address Line | 745 FLETCHER DR STE 202
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City | ELGIN
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State | IL
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Zip | 60123-4747
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Country | US
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Telephone | 847-888-1300
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Fax | 847-888-1341
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Authorized Official
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Title or Position | PRCTICE ADMINISTRATOR
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Name | JOANNE DEMUTH
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Credential |
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Telephone | 847-888-1300
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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 | IL
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