| Prospect Healthcare Sc | |
|
2 E 22nd St Suite 110 Lombard IL 60148-6106 | |
| (630) 376-6317 | |
| (630) 376-6319 |
| Full Name | Prospect Healthcare Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 2 E 22nd St, Lombard, Illinois |
| Authorized Official Name and Position | Gartrell King (PHYSICIAN) |
| Authorized Official Contact | 6303766317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect Healthcare Sc 2 E 22nd St Suite 110 Lombard IL 60148-6106 Ph: (630) 376-6317 | Prospect Healthcare Sc 2 E 22nd St Suite 110 Lombard IL 60148-6106 Ph: (630) 376-6317 |
| NPI Number | 1194044743 |
|---|---|
| Provider Enumeration Date | 05/21/2010 |
| Last Update Date | 09/13/2016 |
| Medicare PECOS PAC ID | 4486841053 |
|---|---|
| Medicare Enrollment ID | O20101208000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194044743 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Secondary |
| Provider Name | Geoffrey R Sebastian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114991163 PECOS PAC ID: 1951298967 Enrollment ID: I20040303001034 |
| Provider Name | John A Stoner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922193994 PECOS PAC ID: 8022001171 Enrollment ID: I20040406000165 |
| Provider Name | Bruce Avram Blacker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982603924 PECOS PAC ID: 9537122783 Enrollment ID: I20041109000046 |
| Provider Name | Mohammad A Toor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841289691 PECOS PAC ID: 2264426212 Enrollment ID: I20050628000341 |
| Provider Name | Marcia Radja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164776670 PECOS PAC ID: 9335389113 Enrollment ID: I20130628000530 |
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