Provider Demographics
NPI:1285957266
Name:G N ENDOCRINOLOGY LTD
Entity type:Organization
Organization Name:G N ENDOCRINOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-440-5350
Mailing Address - Street 1:FIVE KISH HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9602
Mailing Address - Country:US
Mailing Address - Phone:815-748-8335
Mailing Address - Fax:815-748-8340
Practice Address - Street 1:FIVE KISH HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:815-748-8335
Practice Address - Fax:815-748-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124942207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL044049488Medicaid