MEDICARE: SUBURBAN BEHAVIORAL HEALTH INC

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	2084P0800X	Psychiatry Physician	036121444	IL

General Provider Information

NPI Number	:	1851674378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN BEHAVIORAL HEALTH INC

Provider Business Mailing Address
First Line	:	1 S 443 SUMMIT AVE
Second Line	:	SUITE # 201
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3973
Country	:	US
Telephone Number	:	630-613-9800
Fax Number	:	630-613-9865

Provider Business Practice Location Address
First Line	:	263 BALMORAL CT
Second Line	:
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-1306
Country	:	US
Telephone Number	:	331-643-0559
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MAZAR GOLEWALE
Credential	:	MD
Telephone Number	:	331-643-0559

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	04/02/2019

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