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Contact Information

PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC
1225 W LAKE ST
SUITE 409
MELROSE PARK, IL60610
 Phone: 708-499-7510
 Fax: 708-345-0332
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Gastroenterology

2080P0206X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC

NPI Number 1336323484
LBN Legal business name PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC
Authorized official GLORIA BUENTELLO - (MD)
Entity Organization
Organization subpart 1 No
Enumeration date 12/26/2007
Last updated 06/13/2011 - About 15 years ago
Identifiers
IL License # 036062537
IN License # 1000155902
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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