| North Suburban Gastroenterology | |
|
711 W Devon Park Ridge IL 60068-4713 | |
| (847) 696-3176 | |
| (847) 696-2678 |
| Full Name | North Suburban Gastroenterology |
|---|---|
| Speciality | Internal Medicine |
| Location | 711 W Devon, Park Ridge, Illinois |
| Authorized Official Name and Position | Anthony A Grande (PRESIDENT) |
| Authorized Official Contact | 8476963176 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Suburban Gastroenterology 711 W Devon Park Ridge IL 60068-4713 Ph: (847) 696-3176 | North Suburban Gastroenterology 711 W Devon Park Ridge IL 60068-4713 Ph: (847) 696-3176 |
| NPI Number | 1114037041 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 04/06/2011 |
| Medicare PECOS PAC ID | 5698678639 |
|---|---|
| Medicare Enrollment ID | O20040128000814 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114037041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Michelle M Lipman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376548289 PECOS PAC ID: 0143260836 Enrollment ID: I20050512000323 |
| Provider Name | Anthony A Grande |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477558377 PECOS PAC ID: 5799688735 Enrollment ID: I20101018001298 |
| Provider Name | Jeffrey T Brasky |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1891976981 PECOS PAC ID: 3274712484 Enrollment ID: I20110120000222 |
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