Healthcare Provider Details

I. General information

NPI: 1982703856
Provider Name (Legal Business Name): MGM MEDICAL ASSOCIATES, LTD. SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 W 22ND ST SUITE: 211
OAK BROOK IL
60523-1245
US

IV. Provider business mailing address

8345 W MAYNARD RD
NILES IL
60714-1058
US

V. Phone/Fax

Practice location:
  • Phone: 630-368-3909
  • Fax: 630-368-3958
Mailing address:
  • Phone: 847-983-4215
  • Fax: 847-983-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036104910
License Number StateIL

VIII. Authorized Official

Name: DR. MEERA GEORGE MADAPPALLIL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-414-4460