| Aspen Medical Group Llc | |
|
1120 Thompson Blvd Buffalo Grove IL 60089-1021 | |
| (847) 354-8086 | |
| Not Available |
| Full Name | Aspen Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1120 Thompson Blvd, Buffalo Grove, Illinois |
| Authorized Official Name and Position | Alexander Potermin (MEMBER) |
| Authorized Official Contact | 8473548086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aspen Medical Group Llc 1120 Thompson Blvd Buffalo Grove IL 60089-1021 Ph: () - | Aspen Medical Group Llc 1120 Thompson Blvd Buffalo Grove IL 60089-1021 Ph: (847) 354-8086 |
| NPI Number | 1013195932 |
|---|---|
| Provider Enumeration Date | 02/01/2008 |
| Last Update Date | 02/02/2015 |
| Medicare PECOS PAC ID | 2264518802 |
|---|---|
| Medicare Enrollment ID | O20080325000020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013195932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36104917 (Illinois) | Primary |
| Provider Name | Alexander V Potermin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407842958 PECOS PAC ID: 1355320458 Enrollment ID: I20040714000125 |
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