Provider Demographics
NPI:1629155718
Name:CENTER FOR PEDIATRIC GASTROENTEROLOGY & NUTRITION MDSC
Entity Type:Organization
Organization Name:CENTER FOR PEDIATRIC GASTROENTEROLOGY & NUTRITION MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-684-5650
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-5650
Practice Address - Fax:708-684-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL23300OtherADVOCATE HLTH PARTNERS ID
IL01605334OtherBCBC PROVIDER ID
IL23300OtherADVOCATE HLTH PARTNERS ID