Healthcare Provider Details

I. General information

NPI: 1649229840
Provider Name (Legal Business Name): INTENSIVIST GROUP SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL ROAD
ARLINGTON HEIGHTS IL
60005
US

IV. Provider business mailing address

DEPT 4392
CAROL STREAM IL
60122-4392
US

V. Phone/Fax

Practice location:
  • Phone: 866-540-5303
  • Fax:
Mailing address:
  • Phone: 866-540-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAY S COWEN
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 866-344-0543