Provider Demographics
NPI:1083972624
Name:GASTROENTEROLOGY SERVICES ENDOSCOPY SUITE, LTD
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SERVICES ENDOSCOPY SUITE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-969-1167
Mailing Address - Street 1:3825 HIGHLAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1561
Mailing Address - Country:US
Mailing Address - Phone:630-969-1167
Mailing Address - Fax:630-969-1297
Practice Address - Street 1:3825 HIGHLAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1561
Practice Address - Country:US
Practice Address - Phone:630-969-1167
Practice Address - Fax:630-969-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6827 782 5261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy