SUBURBAN METABOLIC INSTITUTE, LLC (NPI# 1659690022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659690022 |
| Entity Type | Organization |
| Organization Name | SUBURBAN METABOLIC INSTITUTE, LLC |
| Practice Address |
3245 Grove Ave Ste. 202 Berwyn IL 60402-3474 |
| Practice Telephone | 7084840621 |
| Practice Fax Number | 7084840250 |
| Mailing Telephone | 7084840621 |
| Mailing Fax Number | 7084840250 |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2010-05-25 |
| Authorized Official Name | DR. RYAN C. HEADLEY (GENERAL SURGEON) |
| Authorized Official Telephone | 7084840621 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | SUBURBAN SURGICAL ASSOCIATES, LTD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 036118355 | IL | Other Service Providers |
| Y | 174400000X | Specialist | 036114720 | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 03611470 | 05 |
| Street Address |
3245 GROVE AVE STE. 202 |
| City | BERWYN |
| State | IL |
| Zip Code | 60402-3474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790783736 | Mercado Foot and Ankle Clinics South | Podiatrist | 3245 Grove Ave, Suite 106, Berwyn, IL 60402-3474 | 2005-07-13 |
| 1689205684 | Maria Perez | Social Worker | 3245 Grove Ave, Berwyn, IL 60402-3474 | 2020-01-29 |
| 1649834409 | Mindfully Serene Pscyhotherapy LLC | Clinic/Center | 3245 Grove Ave, Berwyn, IL 60402-3474 | 2019-04-26 |
| 1841657939 | Mindful Wellness LLC | Counselor | 3245 Grove Ave, Suite 107, Berwyn, IL 60402-3474 | 2016-01-21 |
| 1629328935 | Caitlin Sellers-grudysz | Social Worker | 3245 Grove Ave, Ste 107, Berwyn, IL 60402-3474 | 2012-09-13 |
| 1962774885 | Jennifer Busker | Counselor | 3245 Grove Ave, Suite 107, Berwyn, IL 60402-3474 | 2012-02-08 |
| 1902180201 | Freedom Foot Clinics of Illinois Sc | Podiatrist | 3245 Grove Ave, Suite #103, Berwyn, IL 60402-3474 | 2011-10-05 |
| 1770883779 | S & S Diagnostic Services, Inc | Physiological Laboratory | 3245 Grove Ave, Suite 104, Berwyn, IL 60402-3474 | 2010-10-25 |
| 1912153909 | Robin Lynn Favor | Surgery | 3245 Grove Ave, Suite 202, Berwyn, IL 60402-3474 | 2008-08-11 |
| 1023283611 | Mark S Choh | Surgery | 3245 Grove Ave, #202, Berwyn, IL 60402-3474 | 2008-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619586518 | Lisa K Anderson-shaw | Clinical Ethicist | Macneal Trinity Medical Cetner, 3249 Oak Park Avenue, Berwyn, IL 60402 | 2020-07-27 |
| 1922622380 | Ayesha Ikram | Internal Medicine | Macneal Hospital 3249 S. Oak Park Ave, Brewyn, IL 60402 | 2020-06-02 |
| 1598329146 | Eleanor Teoh | Student in an Organized Health Care Education/Training Program | Family Medicine, Macneal Family Medicine Center, 3231 Eucild Ave, 5th Floor, Berwyn, IL 60402 | 2019-04-30 |
| 1376013920 | Virginia Mireles | Behavior Technician | 2317 S. Home, Berwyn, IL 60402 | 2018-11-27 |
| 1245709047 | Saraswati Koirala | Dentist | 1227 S Harlem Ave Apt414, Berwyn, IL 60402 | 2018-11-21 |
| 1295204220 | Dental Town Ltd | Dentist | 7106 W Cermak Rd, Berwyn, IL 60402 | 2018-11-20 |
| 1396231684 | Toya M Gildart | Counselor | Pillars, 6415 Stanley Avenue, Berwyn, IL 60402 | 2018-07-10 |
| 1437655685 | Ana Luisa Desantiago | Social Worker | 3245 Grove Ave Ste 201, Berwyn, IL 60402 | 2018-04-04 |
| 1821520198 | Chetan Velagapudi | Student in an Organized Health Care Education/Training Program | 3231 S Euclid Avenue, Suite 203, Berwyn, IL 60402 | 2017-03-28 |
| 1174976567 | Sydney Talavera | Counselor | 6415 Stanley Ave., Berwyn, IL 60402 | 2016-07-20 |
| Find all providers in zip 60402 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821525403 | Maria Espejo-schiltz | Specialist | 3245 Grove Ave Ste 205, Berwyn, IL 60402-3476 | 2017-05-15 |
| 1316014723 | Medical Surgical Dermatology, Sc | Specialist | 3253 Harlem Ave, Berwyn, IL 60402-2996 | 2006-11-29 |
| 1710967989 | Allen C. Bernthal | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2006-01-22 |
| 1477974574 | Integrated Pain Management (berwyn) Ltd | Specialist | 3253 Harlem Ave, Unit 5, Berwyn, IL 60402-2996 | 2013-12-17 |
| 1366763534 | Allen C Bernthal M D Ltd | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2010-06-22 |
| 1366626996 | Suburban Urology Associates,ltd | Specialist | 3340 Oak Park Ave, Suite 305, Berwyn, IL 60402-3420 | 2007-12-18 |
| 1821204082 | Suburban Otolaryngology,s.c. | Specialist | 3340 Oak Park Ave, Berwyn, IL 60402-3420 | 2007-05-15 |
| 1750436051 | Gi and Liver Specialists, Ltd | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2007-01-24 |
| 1548315849 | Midwest Nephrology Associates, LLC | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2007-01-24 |
| 1184701328 | Berwyn Emergency Services Sc | Specialist | 3635 Harlem Ave, Berwyn, IL 60402-3212 | 2006-11-01 |
| Find all providers in BERWYN | ||||
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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.