Provider Demographics
NPI:1740368083
Name:SUBURBAN NEUROLOGY GROUP, LLC
Entity type:Organization
Organization Name:SUBURBAN NEUROLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTWANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-208-7790
Mailing Address - Street 1:302 RANDALL RD STE 208
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-208-7790
Mailing Address - Fax:630-563-2814
Practice Address - Street 1:302 RANDALL RD STE 208
Practice Address - Street 2:SUITE 208
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-208-7790
Practice Address - Fax:630-563-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty