Provider Demographics
NPI:1083745251
Name:MIDWEST GASTROENTEROLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:MIDWEST GASTROENTEROLOGY ASSOCIATES LTD
Other - Org Name:MIDWEST GASTRO LTD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHRUVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILWALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-827-0100
Mailing Address - Street 1:17 W 755 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-827-0100
Mailing Address - Fax:630-827-0103
Practice Address - Street 1:17 W 755 BUTTERFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-827-0100
Practice Address - Fax:630-827-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21608842OtherBLUE CROSS BLUE SHIELD
IL21608842OtherBLUE CROSS BLUE SHIELD
IL995270Medicare ID - Type UnspecifiedCOOK COUNTY