Basic Information
| Provider Information | |||||||||
| NPI: | 1376656835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUBURBAN NEONATAL, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2475 | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600652475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735370020 | ||||||||
| FaxNumber: | 7735370030 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600483141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735370020 | ||||||||
| FaxNumber: | 7735370030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FOREMAN | ||||||||
| AuthorizedOfficialFirstName: | SYD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7735370020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.