Healthcare Provider Details

I. General information

NPI: 1043733504
Provider Name (Legal Business Name): MORGAN MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W KENSINGTON RD SUITE 1A
MOUNT PROSPECT IL
60056
US

IV. Provider business mailing address

105 N WESTERN AVE
PARK RIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 847-305-8534
  • Fax:
Mailing address:
  • Phone: 847-436-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARA VORMITTAG
Title or Position: OWNER
Credential: MD
Phone: 847-436-1305