Healthcare Provider Details

I. General information

NPI: 1194861286
Provider Name (Legal Business Name): MEDICALL PHYSICIANS GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E ALGONQUIN RD STE. 504
SCHAUMBURG IL
60173-4187
US

IV. Provider business mailing address

2040 E ALGONQUIN RD STE. 504
SCHAUMBURG IL
60173-4187
US

V. Phone/Fax

Practice location:
  • Phone: 847-397-1215
  • Fax: 847-397-1216
Mailing address:
  • Phone: 847-397-1215
  • Fax: 847-397-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROGER ALAN LUCERO
Title or Position: OWNER
Credential: M.D.
Phone: 847-397-1215