Organization
SUBURBAN EAR,NOSE & THROAT ASSOC., LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LON J PETCHENIK MD (PRESIDENT)
(847) 259-2530
Entity
Organization
Contact information
Practice address
5999 NEW WILKE RD BLDG 1, ROLLING MEADOWS, IL 60008-4506
(847) 259-2530
(847) 259-4930
Mailing address
5999 NEW WILKE RD BLDG 1, ROLLING MEADOWS, IL 60008-4506
(847) 259-2530
(847) 259-4930
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616074
BLUE CROSS
IL
01
—
CF1147
RAILROAD MEDICARE
IL
Enumeration date
10/13/2006
Last updated
11/17/2022
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