# PREMIER SUBURBAN MEDICAL GROUP, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902412950
- **Authorized official:** AMY OWENS (DIRECTOR, FINANCE)
- **Authorized official phone:** (815) 300-7764

## Contact information

- **Practice address:** 17047 LA GRANGE RD., ORLAND PARK, IL 60487-1913
- **Practice address phone:** (815) 300-7664
- **Mailing address:** 1900 SILVER CROSS BLVD, NEW LENOX, IL 60451-9509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/16/2020
- **Last updated:** 05/31/2024