Provider Demographics
NPI:1124379425
Name:SDG INC.,
Entity type:Organization
Organization Name:SDG INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-681-8947
Mailing Address - Street 1:2715 KELLY LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1656
Mailing Address - Country:US
Mailing Address - Phone:847-681-8947
Mailing Address - Fax:866-828-0028
Practice Address - Street 1:2715 KELLY LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1656
Practice Address - Country:US
Practice Address - Phone:847-681-8947
Practice Address - Fax:866-828-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No335G00000XSuppliersMedical Foods Supplier