Healthcare Provider Details

I. General information

NPI: 1417188954
Provider Name (Legal Business Name): PRIMECARE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 S VINCENNES AVE
CHICAGO IL
60621-3506
US

IV. Provider business mailing address

1375 E SCHAUMBURG RD STE 100
SCHAUMBURG IL
60194-3643
US

V. Phone/Fax

Practice location:
  • Phone: 773-224-4800
  • Fax: 847-890-6660
Mailing address:
  • Phone: 773-744-7864
  • Fax: 847-890-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRZA BAIG
Title or Position: CEO
Credential:
Phone: 773-744-7864