Provider Demographics
NPI:1932398518
Name:SUBURBAN SURGERY
Entity Type:Organization
Organization Name:SUBURBAN SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-460-3655
Mailing Address - Street 1:15174 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4349
Mailing Address - Country:US
Mailing Address - Phone:708-460-3655
Mailing Address - Fax:708-873-5873
Practice Address - Street 1:15174 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4349
Practice Address - Country:US
Practice Address - Phone:708-460-3655
Practice Address - Fax:708-873-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical