| Sushilkumar Tibrewala, Md | |
|
3301 Patriot Ct Herrin IL 62948-3782 | |
| (618) 998-8885 | |
| (618) 998-8886 |
| Full Name | Sushilkumar Tibrewala, Md |
|---|---|
| Speciality | Internal Medicine |
| Location | 3301 Patriot Ct, Herrin, Illinois |
| Authorized Official Name and Position | Sushilkunar Mahabirprasad Tibrewala (PRESIDENT) |
| Authorized Official Contact | 6189988885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sushilkumar Tibrewala, Md 24 Pine Lake Dr Carbondale IL 62901-5410 Ph: (618) 529-3308 | Sushilkumar Tibrewala, Md 3301 Patriot Ct Herrin IL 62948-3782 Ph: (618) 998-8885 |
| NPI Number | 1609914183 |
|---|---|
| Provider Enumeration Date | 02/04/2007 |
| Last Update Date | 09/11/2018 |
| Medicare PECOS PAC ID | 5294831343 |
|---|---|
| Medicare Enrollment ID | O20070507000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609914183 | NPI | - | NPPES |
| 0010023397 | Other | IL | BCBS OF IL |
| 036073571 | Medicaid | IL | |
| 173109 | Other | IL | HEALTHLINK PPO |
| 046565 | Other | IL | HEALTH ALLIANCE |
| 833199720 | Other | IL | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 036-073571 (Illinois) | Primary |
| Provider Name | Sushilkumar M Tibrewala |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1457366858 PECOS PAC ID: 0749187276 Enrollment ID: I20031215000163 |
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