Healthcare Provider Details

I. General information

NPI: 1144517830
Provider Name (Legal Business Name): COMPLETE CARE MEDICAL CENTER, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 SUMMIT ST STE 100
ELGIN IL
60120
US

IV. Provider business mailing address

373 SUMMIT ST STE 102
ELGIN IL
60012
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-3631
  • Fax: 847-888-3632
Mailing address:
  • Phone: 847-888-3631
  • Fax: 847-888-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036085859
License Number StateIL

VIII. Authorized Official

Name: DR. ORAWAN SUKAVACHANA
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 847-650-1452