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NPI Code Detail

MEDICARE: SAGE MEDICAL GROUP, SC

MEDICARE: SAGE MEDICAL GROUP, SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianIL

General Provider Information

NPI Number : 1093812364
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAGE MEDICAL GROUP, SC
Provider Business Mailing Address
First Line : 1150 W FULLERTON AVE
Second Line : 2ND FLOOR
City : CHICAGO
State : IL
Zip : 60614-8160
Country : US
Telephone Number : 773-549-7757
Fax Number : 773-549-1221
Provider Business Practice Location Address
First Line : 1150 W FULLERTON AVE
Second Line : 2ND FLOOR
City : CHICAGO
State : IL
Zip : 60614-8160
Country : US
Telephone Number : 773-549-7757
Fax Number : 773-549-1221
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : MRS. CHERYL MUSIL
Credential :
Telephone Number : 773-549-7757
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/01/2007

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Directions to “SAGE MEDICAL GROUP, SC ” Practice Location

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