Healthcare Provider Details

I. General information

NPI: 1376576785
Provider Name (Legal Business Name): PULMONARY MEDICINE ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE
MELROSE PARK IL
60160-1634
US

IV. Provider business mailing address

7607 MADISON ST
FOREST PARK IL
60130-3513
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-4557
  • Fax:
Mailing address:
  • Phone: 708-366-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH M BRUNDAGE
Title or Position: DIRECTOR
Credential:
Phone: 708-366-7177