Provider Demographics
NPI:1619150489
Name:DOWNERS GROVE MEDICAL GROUP
Entity Type:Organization
Organization Name:DOWNERS GROVE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-969-9200
Mailing Address - Street 1:1121 WARREN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3572
Mailing Address - Country:US
Mailing Address - Phone:630-969-9200
Mailing Address - Fax:
Practice Address - Street 1:1034 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3601
Practice Address - Country:US
Practice Address - Phone:630-969-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH6557OtherRAILROAD MEDICARE
IL587930Medicare PIN