Organization
GASTROENTEROLOGY CARE OF SOUTHERN ILLINOIS, LLC
Active
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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