Provider Demographics
NPI:1285755223
Name:ENDOCRINOLOGY ASSOCIATES SC
Entity type:Organization
Organization Name:ENDOCRINOLOGY ASSOCIATES SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SWADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-629-3610
Mailing Address - Street 1:2500 S HIGHLAND AVENUE
Mailing Address - Street 2:STE 104
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5381
Mailing Address - Country:US
Mailing Address - Phone:630-629-3610
Mailing Address - Fax:630-629-4878
Practice Address - Street 1:2500 S HIGHLAND AVENUE
Practice Address - Street 2:STE 104
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5381
Practice Address - Country:US
Practice Address - Phone:630-629-3610
Practice Address - Fax:630-629-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2200624OtherBLUE CROSS BLUE SHIELD
IL288730Medicare PIN