Provider Demographics
NPI:1063695682
Name:SUBURBAN MEDICAL CENTER, S.C
Entity type:Organization
Organization Name:SUBURBAN MEDICAL CENTER, S.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-995-9500
Mailing Address - Street 1:1900 ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-8974
Mailing Address - Country:US
Mailing Address - Phone:847-995-9500
Mailing Address - Fax:847-995-9501
Practice Address - Street 1:380 E NORTHWEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2274
Practice Address - Country:US
Practice Address - Phone:847-382-6870
Practice Address - Fax:847-382-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL40734OtherADVOCATE PHO
IL212292OtherMEDICARE GROUP NUMBER
IL036056234Medicaid
IL4900938OtherBLUE CROSS BLUE SHIELD
IL40734OtherADVOCATE PHO