NPIMap

Organization Active NPI

Great Lakes Endocrine and General Surgery LLC

  • Surgery Physician
  • Burr Ridge, IL
National Provider Identifier
1295197044
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036.098470 Issued in IL
Legal business name
GREAT LAKES ENDOCRINE AND GENERAL SURGERY LLC
Practice address
104 Circle Ridge Dr
Burr Ridge, IL 60527-8379
Phone
(570) 772-7792
NPI assigned
Mar 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Samer Rodwan Rajjoub, M.D.NPI 1891920120
Title
President
Phone
(570) 772-7792

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 036.098470 IL Primary

Addresses

Primary practice location

104 Circle Ridge Dr
Burr Ridge, IL 60527-8379

Mailing address

104 Circle Ridge Dr
Burr Ridge, IL 60527-8379
Phone (570) 772-7792

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1295197044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CIRCLE RIDGE DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605278379",
            "telephone_number": "570-772-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CIRCLE RIDGE DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605278379",
            "telephone_number": "570-772-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ENDOCRINE AND GENERAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "RAJJOUB",
        "authorized_official_first_name": "SAMER",
        "authorized_official_middle_name": "RODWAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-772-7792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.098470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.