MEDICARE: SUBURBAN INTERNAL MEDICINE SC

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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1639276793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN INTERNAL MEDICINE SC

Provider Business Mailing Address
First Line	:	550 N LAKE ST
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-1827
Country	:	US
Telephone Number	:	847-566-5200
Fax Number	:	847-566-5522

Provider Business Practice Location Address
First Line	:	550 N LAKE ST
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-1827
Country	:	US
Telephone Number	:	847-566-5200
Fax Number	:	847-566-5522

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRUCE DAVID HYMAN
Credential	:	M.D.
Telephone Number	:	847-566-5200

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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