Healthcare Provider Details

I. General information

NPI: 1902247224
Provider Name (Legal Business Name): US MEDGROUP OF ILLINOIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 S HARLEM AVE
BRIDGEVIEW IL
60455-1905
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 708-430-2295
  • Fax: 708-430-2372
Mailing address:
  • Phone: 972-364-8000
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAAD YALDO
Title or Position: PRESIDENT AND TREASURER
Credential: DO
Phone: 972-364-8000