MEDICARE: SUBURBAN GASTROENTEROLOGY LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1114954633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN GASTROENTEROLOGY LTD

Provider Business Mailing Address
First Line	:	640 S WASHINGTON ST
Second Line	:	SUITE 240
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6603
Country	:	US
Telephone Number	:	630-527-6450
Fax Number	:	630-527-6456

Provider Business Practice Location Address
First Line	:	640 S WASHINGTON ST
Second Line	:	SUITE 240
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6603
Country	:	US
Telephone Number	:	630-527-6450
Fax Number	:	630-527-6456

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DINESH JAIN
Credential	:	M.D.
Telephone Number	:	630-527-6450

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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