Provider Demographics
NPI:1407824006
Name:DOWNERS GROVE INTERNISTS, S.C.
Entity Type:Organization
Organization Name:DOWNERS GROVE INTERNISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-963-9667
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-963-9667
Mailing Address - Fax:630-963-9936
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-963-9667
Practice Address - Fax:630-963-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX I.D.
IL=========OtherTAX I.D.