Provider Demographics
NPI:1326174491
Name:DIGESTIVE DISEASE CLINIC OF JOLIET LTD
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CLINIC OF JOLIET LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-744-6722
Mailing Address - Street 1:3077 W JEFFERSON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5262
Mailing Address - Country:US
Mailing Address - Phone:815-744-6722
Mailing Address - Fax:815-744-6733
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-744-6722
Practice Address - Fax:815-744-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty