Provider Demographics
NPI:1114037041
Name:NORTH SUBURBAN GASTROENTEROLOGY
Entity Type:Organization
Organization Name:NORTH SUBURBAN GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-696-3176
Mailing Address - Street 1:711 W DEVON
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4713
Mailing Address - Country:US
Mailing Address - Phone:847-696-3176
Mailing Address - Fax:847-696-2678
Practice Address - Street 1:711 W DEVON
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4713
Practice Address - Country:US
Practice Address - Phone:847-696-3176
Practice Address - Fax:847-696-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty