Provider Demographics
NPI:1942376256
Name:SUBURBAN OB GYN LTD
Entity Type:Organization
Organization Name:SUBURBAN OB GYN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-569-2424
Mailing Address - Street 1:3009 N BALLAS ROAD
Mailing Address - Street 2:SUITE 366C
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-569-2424
Mailing Address - Fax:314-569-2158
Practice Address - Street 1:3009 N BALLAS ROAD
Practice Address - Street 2:SUITE 366C
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-569-2424
Practice Address - Fax:314-569-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty