Pediatric and Adolescent Gastroenterology Group Inc

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

036062537 Issued in IL

Legal business name

PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC

Practice address

1225 W Lake St
Suite 409
Melrose Park, IL 60610

Phone

(708) 499-7510

Fax

(708) 345-0332

NPI assigned

Dec 26, 2007

Organization subpart

No

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

Authorized official

Name

Gloria Buentello, MDNPI 1518977875

Title

MD

Phone

(708) 499-7510

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Gloria Buentello, M.D.

  • Pediatric Gastroenterology Physician
  • Melrose Park, IL
  • NPI 1518977875
  NPD (past) Authorized official

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1336323484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 W DIVISION ST UNIT 142",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606102220",
            "telephone_number": "708-499-7510",
            "fax_number": "708-345-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W LAKE ST",
            "address_2": "SUITE 409",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "60610",
            "telephone_number": "708-499-7510",
            "fax_number": "708-345-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "BUENTELLO",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "708-499-7510",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IL",
            "license": "036062537",
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IN",
            "license": "1000155902",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shobhana Patodia, MD
• Melvyn Payton Jr.
• PCC Community Wellness Center
• Terri L. Pearson, MA
• Bradley M. Pechter, M.D.
• Kayla Perez, FNP
• Vicente Perez
• Dana C. Perry, M.D.
• Peter E Eupierre M.D P.C
• Megan Leigh Peterson, MA, CCC-SLP

• Pediatric Gastroenterology Physician in Melrose Park, IL
• Providers in Melrose Park, IL by specialty
• Pediatric Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; 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.