PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC (NPI# 1336323484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1336323484 |
Entity Type | Organization |
Organization Name | PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC |
Practice Address |
1225 W Lake St Suite 409 Melrose Park IL 60610 |
Mailing Address |
47 W Division St Unit 142 Chicago IL 60610-2220 |
Practice Telephone | 7084997510 |
Practice Fax Number | 7083450332 |
Mailing Telephone | 7084997510 |
Mailing Fax Number | 7083450332 |
Enumeration Date | 2007-12-26 |
Last Update Date | 2011-06-13 |
Authorized Official Name | GLORIA BUENTELLO (MD) |
Authorized Official Telephone | 7084997510 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
1000155902 | IN | Allopathic & Osteopathic Physicians |
Y | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
036062537 | IL | Allopathic & Osteopathic Physicians |
Street Address |
1225 W LAKE ST SUITE 409 |
City | MELROSE PARK |
State | IL |
Zip Code | 60610 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578562351 | Manuel C. Iglesias | Internal Medicine | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2005-07-14 |
1376190975 | Tomas A Estacio | Physical Therapist | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2019-08-20 |
1326511619 | Pipeline - Lakefront Medical Associates, LLC | Preventive Medicine | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2019-01-09 |
1205308756 | Cassadana Kirk | Physician Assistant | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2018-12-21 |
1699241612 | Pipeline-westlake Hospital, LLC | Rehabilitation Unit | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2018-10-17 |
1780150714 | Pipeline-westlake Hospital, LLC | Psychiatric Unit | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2018-10-17 |
1609341320 | Pipeline-westlake Hospital, LLC | General Acute Care Hospital | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2018-10-09 |
1740772003 | Megan Leigh Peterson | Speech-Language Pathologist | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2018-06-03 |
1164923728 | Lindsay Smaron | Speech-Language Pathologist | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2018-02-27 |
1033624937 | Sarah Benning | Occupational Therapist | 1225 W Lake St, Melrose Park, IL 60160-4039 | 2017-12-13 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326683145 | Roslyn M Jordan | Counselor | 860 N. Lasalle, Chicago, IL 60610 | 2019-11-15 |
1992278196 | Deangela Roberson | Specialist/Technologist, Other | 1212 N. Lasalle, Ste 100/ Surgery Center, Chicago, IL 60610 | 2019-01-10 |
1477053205 | Terri Lynn Tyson | Counselor | 1250 N. Dearborn St., 18b, Chicago, IL 60610 | 2018-02-19 |
1487153797 | Jennifer Quinn | Social Worker | 1200 N. Lasalle Street, Chicago, IL 60610 | 2018-02-02 |
1811415334 | Erin Conroy | Behavioral Analyst | 1400 North Lake Shore Drive Apt 8a, Chicago, IL 60610 | 2017-09-05 |
1659898674 | Courtney Jane Busing | Speech-Language Pathologist | 1211 N Lasalle, 903, Chicago, IL 60610 | 2017-08-30 |
1528503042 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 908 North State Street, Chicago, IL 60610 | 2016-12-20 |
1548702814 | Melissa Snyder | Counselor | 1820 N Lasalle Blvd, Counseling- Sweeting, Chicago, IL 60610 | 2016-11-17 |
1982146908 | Samantha Ruth Slagh | Physical Therapist | 1100 N Lasalle Street, Apt 1018, Chicago, IL 60610 | 2016-11-08 |
1891242426 | Stephanie Pinsler | Counselor | 100 W Chestnut, #1907, Chicago, IL 60610 | 2016-09-01 |
Find all providers in zip 60610 |
Taxonomy Code | 2080P0206X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Pediatric Gastroenterology |
A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518977875 | Gloria Buentello | Pediatrics | 1225 W Lake St., Suite 409, Melrose Park, IL 60160 | 2006-08-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578799482 | Tiffany J. Patton | Pediatrics | 5839 S. Maryland Ave., Wyler C-474, Mc 4065, Chicago, IL 60637-1470 | 2009-06-05 |
1982860755 | Joshua Prozialeck | Pediatrics | 225 E Chicago Ave # 65, Chicago, IL 60611-2991 | 2008-07-31 |
1881866259 | Lee Michael Bass | Pediatrics | 2300 N Childrens Plz # 65, Chicago, IL 60614-3363 | 2008-03-26 |
1457578023 | Nancy M. Mcgreal | Pediatrics | 5839 S. Maryland Avenue, Mc 4065, Chicago, IL 60637 | 2007-04-18 |
1649300385 | Barbara S. Kirschner | Pediatrics | University of Chicago, Peds Gastro, 5839 South Maryland Avenue, Mc 4065, Chicago, IL 60637-1470 | 2007-03-06 |
1679603302 | Stefano Guandalini | Pediatrics | University of Chicago, Section of Peds Gastro, 5839 South Maryland Avenue, Mc 4065, Chicago, IL 60637-1470 | 2007-03-06 |
1972611234 | Valeria C Cohran | Pediatrics | 2300 Children's Plaza, Box 65, Children's Memorial Hospital, Chicago, IL 60614-3394 | 2006-08-28 |
1598726432 | Timothy A Sentongo | Pediatrics | 5839 S. Maryland Ave, Mc 4065, Chicago, IL 60637 | 2006-03-30 |
1306806518 | Christopher Mullett | Pediatrics | 420 Ne Glen Oak Avenue, Ste 401, Peoria, IL 61603 | 2006-03-23 |
1588650139 | Suzanne P Nelson | Pediatrics | 2551 Compass Rd, Suite 110, Glenview, IL 60026-8045 | 2005-09-20 |
Find all providers with the same taxonomy |
City | MELROSE PARK |
Zip Code | 60610 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.