MEDICARE: FAMILY MEDICAL ASSOCIATES, 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
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00403792	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1623802	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1174609226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL ASSOCIATES, SC

Provider Business Mailing Address
First Line	:	1107 N. PROSPECT AVE
Second Line	:	SUITE 100
City	:	ITASCA
State	:	IL
Zip	:	60143-1408
Country	:	US
Telephone Number	:	630-467-0101
Fax Number	:	630-467-0707

Provider Business Practice Location Address
First Line	:	1107 N. PROSPECT AVE
Second Line	:	SUITE 100
City	:	ITASCA
State	:	IL
Zip	:	60143-1408
Country	:	US
Telephone Number	:	630-467-0101
Fax Number	:	630-467-0707

Authorized Official
Title or Position	:	PATIENT ACCOUNT REPRESENTATIVE
Name	:	MRS. SHITAL PATEL
Credential	:
Telephone Number	:	630-467-0101

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	11/10/2010

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Directions to “FAMILY MEDICAL ASSOCIATES, SC ” Practice Location

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