MEDICARE: PRIME MEDICAL CENTER LTD

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	036103707	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427383025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MEDICAL CENTER LTD

Provider Business Mailing Address
First Line	:	6102 N SHERIDAN RD APT 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2866
Country	:	US
Telephone Number	:	773-430-8312
Fax Number	:	708-730-7298

Provider Business Practice Location Address
First Line	:	6201 N CALIFORNIA AVE STE 110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2672
Country	:	US
Telephone Number	:	773-430-8312
Fax Number	:	708-730-7298

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IQBAL E BHWANI
Credential	:	MD
Telephone Number	:	773-430-8312

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	03/30/2011

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