Provider Demographics
NPI:1366562480
Name:SOUTHWEST DIGESTIVE DISEASES CONSULTANTS S C
Entity type:Organization
Organization Name:SOUTHWEST DIGESTIVE DISEASES CONSULTANTS S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SADNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-375-6500
Mailing Address - Street 1:PO BOX 4527
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-4527
Mailing Address - Country:US
Mailing Address - Phone:630-820-4040
Mailing Address - Fax:
Practice Address - Street 1:1256 WATERFORD DR
Practice Address - Street 2:SUITE 120
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4511
Practice Address - Country:US
Practice Address - Phone:630-820-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211561Medicare ID - Type Unspecified