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SOUTH SUBURBAN GASTROENTEROLOGY S.C. NPI 1417167040


NPI Information

NPI: 1417167040
Provider Name: SOUTH SUBURBAN GASTROENTEROLOGY, S.C.
Classification: Internal Medicine - 207RG0100X
Entity Type: Organization

Specialization: Gastroenterology

CLIA Number: 14D0687237

Address:
17901 GOVERNORS HWY
SUITE 106
HOMEWOOD, IL
ZIP 60430
Phone: (708) 799-3305
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SOUTH SUBURBAN GASTROENTEROLOGY, S.C. is a gastroenterology internal medicine in Homewood, IL. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. SOUTH SUBURBAN GASTROENTEROLOGY, S.C. NPI is 1417167040. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

17901 GOVERNORS HWY
SUITE 106
HOMEWOOD, IL
ZIP 60430-144
Phone: (708) 799-3305
Fax: (708) 799-8592

The provider's authorized official is Abraham Fallah .
The authorized official title is President and has the following contact phone number (708) 799-3305.

The CLIA number assigned to this NPI record is 14D0687237 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/23/2007 and was last updated on 4/17/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RG0100XInternal MedicineGastroenterology04203735ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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