Provider Demographics
NPI:1225130248
Name:WEST SUBURBAN INTERNISTS INC
Entity Type:Organization
Organization Name:WEST SUBURBAN INTERNISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:WHITNEY
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-237-8395
Mailing Address - Street 1:65 WALNUT ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-237-3395
Mailing Address - Fax:781-237-3397
Practice Address - Street 1:65 WALNUT ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-237-3395
Practice Address - Fax:781-237-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20879Medicare PIN