Healthcare Provider Details

I. General information

NPI: 1740129253
Provider Name (Legal Business Name): ILLINOIS GROUP 2023 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 CASCADE DR
SAVOY IL
61874-4403
US

IV. Provider business mailing address

1002 CASCADE DR
SAVOY IL
61874-4403
US

V. Phone/Fax

Practice location:
  • Phone: 423-946-3076
  • Fax:
Mailing address:
  • Phone: 423-946-3076
  • 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: DR. RICKY BHIMANI
Title or Position: MANAGER
Credential: MD
Phone: 423-946-3076