NPIMap

Organization Active NPI

South Suburban Gastroenterology, S.C.

  • Gastroenterology Physician
  • Homewood, IL
National Provider Identifier
1417167040
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
04203735 Issued in IL
Legal business name
SOUTH SUBURBAN GASTROENTEROLOGY, S.C.
Practice address
17901 Governors Hwy
Suite 106
Homewood, IL 60430-1144
Phone
(708) 799-3305
Fax
(708) 799-8592
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

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

Authorized official

Name
Dr. Abraham Fallah, M.D.
Title
President
Phone
(708) 799-3305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0100X 04203735 IL Primary

Addresses

Primary practice location

17901 Governors Hwy
Suite 106
Homewood, IL 60430-1144

Mailing address

17901 Governors Hwy
Suite 106
Homewood, IL 60430-1144
Phone (708) 799-3305

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1417167040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17901 GOVERNORS HWY",
            "address_2": "SUITE 106",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604301144",
            "telephone_number": "708-799-3305",
            "fax_number": "708-799-8592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17901 GOVERNORS HWY",
            "address_2": "SUITE 106",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604301144",
            "telephone_number": "708-799-3305",
            "fax_number": "708-799-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SUBURBAN GASTROENTEROLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "FALLAH",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-799-3305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "04203735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homewood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.