Healthcare Provider Details

I. General information

NPI: 1205814118
Provider Name (Legal Business Name): PHYSICIANS IMMEDIATE CARE NORTH CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 N CICERO AVE SUITE 100
CHICAGO IL
60641-1651
US

IV. Provider business mailing address

PO BOX 500
ELLICOTTVILLE NY
14731-0500
US

V. Phone/Fax

Practice location:
  • Phone: 815-713-2738
  • Fax: 815-986-4217
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BIERNBAUM
Title or Position: OWNER
Credential: DO
Phone: 585-430-8600