Healthcare Provider Details

I. General information

NPI: 1558775502
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF ELGIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N RANDALL RD SUITE 110
ELGIN IL
60123-7900
US

IV. Provider business mailing address

1750 N RANDALL RD SUITE 110
ELGIN IL
60123-7900
US

V. Phone/Fax

Practice location:
  • Phone: 224-629-4525
  • Fax: 847-719-0341
Mailing address:
  • Phone: 224-629-4525
  • Fax: 847-719-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036129040
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36103130
License Number StateIL

VIII. Authorized Official

Name: CINDY A HOLTZ
Title or Position: PRACTICE MANAGER
Credential: RHIT
Phone: 224-629-4525