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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