Provider Demographics
NPI:1871093047
Name:GI PARTNERS OF ILLINOIS, LLC
Entity type:Organization
Organization Name:GI PARTNERS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-602-8253
Mailing Address - Street 1:1615 N CONVENT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1081
Mailing Address - Country:US
Mailing Address - Phone:815-602-8253
Mailing Address - Fax:
Practice Address - Street 1:1615 N CONVENT ST STE 1
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1081
Practice Address - Country:US
Practice Address - Phone:815-602-8253
Practice Address - Fax:815-937-2063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GI PARTNERS OF ILLINOIS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty