Provider Demographics
NPI:1639276793
Name:SUBURBAN INTERNAL MEDICINE SC
Entity Type:Organization
Organization Name:SUBURBAN INTERNAL MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-566-5200
Mailing Address - Street 1:550 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1827
Mailing Address - Country:US
Mailing Address - Phone:847-566-5200
Mailing Address - Fax:847-566-5522
Practice Address - Street 1:550 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1827
Practice Address - Country:US
Practice Address - Phone:847-566-5200
Practice Address - Fax:847-566-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
277530Medicare ID - Type Unspecified