Organization
CENTER FOR STUDY GU DISEASES
Active
Organization
CENTER FOR STUDY GU DISEASES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER E SMITH (BILLING AGENT)
(815) 965-8505
Entity
Organization
Contact information
Practice address
650 SPRING HILL RING RD STE 2000, WEST DUNDEE, IL 60118-1297
(847) 836-8270
Mailing address
4525 FOREST VIEW AVE, ROCKFORD, IL 61108-6406
(815) 965-8505
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532219
BCBS ID
IL
Enumeration date
07/03/2007
Last updated
08/22/2020
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