Provider Demographics
NPI:1003977901
Name:SUBURBAN GENERAL SURGERY LTD
Entity Type:Organization
Organization Name:SUBURBAN GENERAL SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-6370
Mailing Address - Street 1:4700 W 95TH ST
Mailing Address - Street 2:STE 308
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-425-6370
Mailing Address - Fax:708-425-6416
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:STE 308
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-425-6370
Practice Address - Fax:708-425-6416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617379OtherBLUE CROSS BLUE SHIELD
IL751430Medicare PIN