Organization
PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC
Active
Organization
PEDIATRIC AND ADOLESCENT GASTROENTEROLOGY GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA BUENTELLO MD (MD)
(708) 499-7510
Entity
Organization
Contact information
Practice address
1225 W LAKE ST, SUITE 409, MELROSE PARK, IL 60610
(708) 499-7510
(708) 345-0332
Mailing address
47 W DIVISION ST UNIT 142, CHICAGO, IL 60610-2220
(708) 499-7510
(708) 345-0332
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
036062537
IL
2080P0206X
Pediatric Gastroenterology Physician
1000155902
IN
Other
Enumeration date
12/26/2007
Last updated
06/13/2011
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