Provider Demographics
NPI:1043046949
Name:SUBURBAN NEUROLOGY
Entity type:Organization
Organization Name:SUBURBAN NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-646-8352
Mailing Address - Street 1:11 DOUGLAS AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5590
Mailing Address - Country:US
Mailing Address - Phone:630-299-4342
Mailing Address - Fax:630-405-5857
Practice Address - Street 1:11 DOUGLAS AVE STE 253
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5590
Practice Address - Country:US
Practice Address - Phone:630-299-4342
Practice Address - Fax:630-405-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty