NPIMap

Organization Active NPI

Medicine & Surgery SC

  • Gastroenterology Physician
  • Chicago, IL
National Provider Identifier
1932480506
Registry record updated Sep 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
036081654 Issued in IL
Legal business name
MEDICINE & SURGERY SC
Practice address
11250 S Western Ave
Chicago, IL 60643-4116
Phone
(773) 779-7500
NPI assigned
Sep 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2011

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

Authorized official

Name
Kevin J Dolehide, D.O.
Title
Owner
Phone
(773) 779-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 036081654 IL Primary

Addresses

Primary practice location

11250 S Western Ave
Chicago, IL 60643-4116

Mailing address

11250 S Western Ave
Chicago, IL 60643-4116
Phone (773) 779-7500

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1932480506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11250 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434116",
            "telephone_number": "773-779-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11250 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434116",
            "telephone_number": "773-779-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE & SURGERY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-08",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "DOLEHIDE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-779-7500",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036081654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.