1912956962 NPI number — ASSOCIATES IN DIGESTIVE DISEASES, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912956962 NPI number — ASSOCIATES IN DIGESTIVE DISEASES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN DIGESTIVE DISEASES, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912956962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 S YORK RD
Provider Second Line Business Mailing Address:
SUITE 3250
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-5626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-758-8889
Provider Business Mailing Address Fax Number:
630-758-8705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S YORK RD
Provider Second Line Business Practice Location Address:
SUITE 3250
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-5626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-758-8889
Provider Business Practice Location Address Fax Number:
630-758-8705
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUBLETTE
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
630-758-8889

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  036-059182 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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