Provider Demographics
NPI:1154363687
Name:GASTROENTEROLOGY GROUP PRACTICE, LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY GROUP PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BREGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-262-7400
Mailing Address - Street 1:302 RANDALL RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-262-7400
Mailing Address - Fax:630-262-3760
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:SUITE 303
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-262-7400
Practice Address - Fax:630-262-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL571250Medicare ID - Type UnspecifiedGROUP ID