MEDICARE: PRIMECARE MEDICAL ASSOCIATES

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417188954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMECARE MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1375 E SCHAUMBURG RD STE 100
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-3643
Country	:	US
Telephone Number	:	773-744-7864
Fax Number	:	847-890-6660

Provider Business Practice Location Address
First Line	:	7114 S VINCENNES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3506
Country	:	US
Telephone Number	:	773-224-4800
Fax Number	:	847-890-6660

Authorized Official
Title or Position	:	CEO
Name	:	MIRZA BAIG
Credential	:
Telephone Number	:	773-744-7864

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	08/04/2010

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