Provider Demographics
NPI:1164469573
Name:SOUTH SUBURBAN ARTHRITIS GROUP SC
Entity Type:Organization
Organization Name:SOUTH SUBURBAN ARTHRITIS GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-481-4900
Mailing Address - Street 1:2555 W. LINCOLN HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:708-481-4900
Mailing Address - Fax:708-481-9440
Practice Address - Street 1:2555 W. LINCOLN HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-481-4900
Practice Address - Fax:708-481-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063879207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF9106OtherRAILROAD MEDICARE
IL01622409OtherBCBS ID
IL0=========OtherTAX ID
IL01622409OtherBCBS ID
ILCF9106OtherRAILROAD MEDICARE