Illinois Medical Group Sc
Clinic/Center, Multi-Specialty in Chicago, IL. Organization (NPI-2).
NPI number1649219007
StatusActive
Last updated in NPPESJun 12, 2008
Details
- NPI
- 1649219007
- Entity type
- Organization (NPI-2)
- Legal business name
- Illinois Medical Group Sc
- Organization subpart
- No
- Enumeration date
- Jun 4, 2006
- Last updated
- Jun 12, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | 042618822 | IL | Yes |
Practice location
4211 N Cicero AveChicago, IL 60641-1651
Phone 773-545-6900 · Fax 773-685-2481
Mailing address
4211 N Cicero AveChicago, IL 60641-1651
Phone 773-545-6900 · Fax 773-685-2481
Authorized official
Sarmed G Elias
President
7735456900
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