Provider Demographics
NPI:1760735377
Name:SUBURBAN MEDICAL & REHAB CLINIC, LTD
Entity Type:Organization
Organization Name:SUBURBAN MEDICAL & REHAB CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDVEKHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-530-9317
Mailing Address - Street 1:269 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1636
Mailing Address - Country:US
Mailing Address - Phone:847-807-5502
Mailing Address - Fax:847-807-5508
Practice Address - Street 1:269 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-1636
Practice Address - Country:US
Practice Address - Phone:847-807-5502
Practice Address - Fax:847-807-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110569Medicaid
IL036110569Medicaid