| South Suburban Gastroenterology, S.c. | |
|
17901 Governors Hwy Suite 106 Homewood IL 60430-1144 | |
| (708) 799-3305 | |
| (708) 799-8592 |
| Full Name | South Suburban Gastroenterology, S.c. |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 17901 Governors Hwy, Homewood, Illinois |
| Authorized Official Name and Position | Abraham Fallah (PRESIDENT) |
| Authorized Official Contact | 7087993305 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Suburban Gastroenterology, S.c. 17901 Governors Hwy Suite 106 Homewood IL 60430-1144 Ph: (708) 799-3305 | South Suburban Gastroenterology, S.c. 17901 Governors Hwy Suite 106 Homewood IL 60430-1144 Ph: (708) 799-3305 |
| NPI Number | 1417167040 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 04/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417167040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 04203735 (Illinois) | Primary |
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