Provider Demographics
NPI:1942207907
Name:GASTROINTESTINAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:GASTROINTESTINAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-208-7388
Mailing Address - Street 1:302 RANDALL RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-208-7388
Mailing Address - Fax:630-208-4818
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:SUITE 308
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-208-7388
Practice Address - Fax:630-208-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0055909-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK6933OtherRR MEDICARE NUMBER
IL4532084OtherBCBS GROUP NUMBER
IL203529Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER