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General NPI Number Information
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NPI Number | 1003406000
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Entity Type | Organization
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Legal Business Name | PREMIER PRIMARY CARE AND ALTERNATIVE MEDICINE
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 1301 E 47TH STREET BLDG 2 SUITE B
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City | CHICAGO
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State | IL
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Zip | 60653
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Country | US
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Telephone | 773-891-2890
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Fax | 773-891-4107
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Provider Business Mailing Address
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Address Line | 1301 E 47TH STREET BLDG 2 SUITE B
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City | CHICAGO
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State | IL
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Zip | 60653
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Country | US
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Telephone | 773-891-2890
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Fax | 773-891-4107
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Authorized Official
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Title or Position | CHIEF OPERATION OFFICER
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Name | REUBEN C RUTLAND I
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Credential | MD, MBA
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Telephone | 574-276-7184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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