Provider Demographics
NPI:1356398614
Name:SUBURBAN NEUROLOGISTS, S.C.
Entity type:Organization
Organization Name:SUBURBAN NEUROLOGISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-952-9140
Mailing Address - Street 1:943 N PLUM GROVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4779
Mailing Address - Country:US
Mailing Address - Phone:847-952-9140
Mailing Address - Fax:847-952-9145
Practice Address - Street 1:943 N PLUM GROVE RD STE B
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4779
Practice Address - Country:US
Practice Address - Phone:847-952-9140
Practice Address - Fax:847-952-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360389582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL569560OtherGROUP