| Illinois Medical Group Sc | |
|
4211 N Cicero Ave Chicago IL 60641-1651 | |
| (773) 545-6900 | |
| (773) 685-2481 |
| Full Name | Illinois Medical Group Sc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4211 N Cicero Ave, Chicago, Illinois |
| Authorized Official Name and Position | Sarmed G Elias (PRESIDENT) |
| Authorized Official Contact | 7735456900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Medical Group Sc 4211 N Cicero Ave Chicago IL 60641-1651 Ph: (773) 545-6900 | Illinois Medical Group Sc 4211 N Cicero Ave Chicago IL 60641-1651 Ph: (773) 545-6900 |
| NPI Number | 1649219007 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649219007 | NPI | - | NPPES |
| DG1734 | Other | IL | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 042618822 (Illinois) | Primary |
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