Basic Information
| Provider Information | |||||||||
| NPI: | 1861970626 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUBURBAN PULMONARY & CRITICAL CARE ASSOC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 466 | ||||||||
| Address2: | |||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605590466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473768969 | ||||||||
| FaxNumber: | 7732838688 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 ERIE CT STE 7010 | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473768969 | ||||||||
| FaxNumber: | 7732838688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2018 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | JOLEPALEM | ||||||||
| AuthorizedOfficialFirstName: | JYOTHI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8473768969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.