Healthcare Provider Details

I. General information

NPI: 1639375637
Provider Name (Legal Business Name): CALIFORNIA DEVON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 SOUTH MILWAUKEE AVE.
WHEELING IL
60090
US

IV. Provider business mailing address

342 SOUTH MILWAUKEE AVE.
WHEELING IL
60090
US

V. Phone/Fax

Practice location:
  • Phone: 847-520-8909
  • Fax: 847-520-8929
Mailing address:
  • Phone: 847-520-8909
  • Fax: 847-520-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. BORIS GUREVICH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 847-520-8909