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NPI Code Detail

MEDICARE: DEARBORN MEDICAL CONSULTANTS, LLC

MEDICARE: DEARBORN MEDICAL CONSULTANTS, LLC
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
1208VP0014XInterventional Pain Medicine Physician336051334IL

General Provider Information

NPI Number : 1124327994
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEARBORN MEDICAL CONSULTANTS, LLC
Provider Business Mailing Address
First Line : 2720 S RIVER RD
Second Line : SUITE 218
City : DES PLAINES
State : IL
Zip : 60018-4106
Country : US
Telephone Number : 312-280-4700
Fax Number :
Provider Business Practice Location Address
First Line : 712 N DEARBORN ST
Second Line : SUITE 200
City : CHICAGO
State : IL
Zip : 60654-3818
Country : US
Telephone Number : 312-280-4700
Fax Number :
Authorized Official
Title or Position : VP BUSINESS DEVELOPMENT
Name : MR. PAUL KRUEGER
Credential :
Telephone Number : 847-275-2648
Provider Enumeration Date : 03/19/2011
Last Update Date : 03/19/2011

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