Organization
GASTROENTEROLOGY CARE OF SOUTHERN ILLINOIS, LLC
Active
Other names
Sushilkumar Tibrewala, MD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SUSHILKUNAR MAHABIRPRASAD TIBREWALA M.D. (PRESIDENT)
(618) 998-8885
Entity
Organization
Contact information
Practice address
3301 PATRIOT CT, HERRIN, IL 62948-3782
(618) 998-8885
(618) 998-8886
Mailing address
24 PINE LAKE DR, CARBONDALE, IL 62901-5410
(618) 534-1935
(618) 998-8886
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036-073571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010023397
BCBS OF IL
IL
05
—
036073571
—
IL
01
—
046565
HEALTH ALLIANCE
IL
01
—
173109
HEALTHLINK PPO
IL
01
—
833199720
AETNA
IL
Enumeration date
02/04/2007
Last updated
07/04/2025
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