Provider Demographics
NPI:1114357845
Name:SUBURBAN INFECTIOUS DISEASE LLC
Entity Type:Organization
Organization Name:SUBURBAN INFECTIOUS DISEASE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFECTIOUS DISEASE SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-207-1831
Mailing Address - Street 1:3800 W 203RD ST
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461
Mailing Address - Country:US
Mailing Address - Phone:708-207-1831
Mailing Address - Fax:
Practice Address - Street 1:3800 W 203RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-207-1831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105849282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital