| I-squared Medical Group | |
|
1100 Lake St Ste 125 Oak Park IL 60301-6702 | |
| (773) 490-5611 | |
| (312) 276-8684 |
| Full Name | I-squared Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1100 Lake St Ste 125, Oak Park, Illinois |
| Authorized Official Name and Position | Dominic D Patawaran (CO-OWNER) |
| Authorized Official Contact | 7734905611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| I-squared Medical Group Po Box 25816 Chicago IL 60625-8616 Ph: (773) 490-5611 | I-squared Medical Group 1100 Lake St Ste 125 Oak Park IL 60301-6702 Ph: (773) 490-5611 |
| NPI Number | 1912559303 |
|---|---|
| Provider Enumeration Date | 07/15/2019 |
| Last Update Date | 07/15/2019 |
| Medicare PECOS PAC ID | 4789914920 |
|---|---|
| Medicare Enrollment ID | O20191001001866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912559303 | NPI | - | NPPES |
| 036899826 | Other | IL | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Dominic D Patawaran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902873342 PECOS PAC ID: 4587612635 Enrollment ID: I20130122000509 |
| Provider Name | Daisy T Wynn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982820643 PECOS PAC ID: 9739226267 Enrollment ID: I20131122000310 |
| Provider Name | Angel Luis Rivera |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629218235 PECOS PAC ID: 5395962450 Enrollment ID: I20140813001626 |
| Provider Name | Sejal Gehani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548285414 PECOS PAC ID: 2466758099 Enrollment ID: I20170302000832 |
| Provider Name | Disha Japa |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629696752 PECOS PAC ID: 5991299984 Enrollment ID: I20251208002052 |
| Provider Name | Emily Daley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003388927 PECOS PAC ID: 0749710010 Enrollment ID: I20260526000085 |
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