Healthcare Provider Details

I. General information

NPI: 1295332104
Provider Name (Legal Business Name): PRIMA MEDICAL PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 110
PARK RIDGE IL
60068-1125
US

IV. Provider business mailing address

541 HELEN DR
NORTHBROOK IL
60062-2527
US

V. Phone/Fax

Practice location:
  • Phone: 847-897-9010
  • Fax: 847-692-2129
Mailing address:
  • Phone: 847-897-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LARISA LEV
Title or Position: OWNER
Credential:
Phone: 847-897-9010