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General NPI Number Information
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NPI Number | 1063841393
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Entity Type | Organization
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Legal Business Name | SCHAUMBURG PRIMARY MEDICAL CENTER
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 2200 S MAIN ST SUITE 105
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 773-744-7864
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 S MAIN ST SUITE 105
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 773-744-7864
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Fax |
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Authorized Official
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Title or Position | CREDENTIAL MGR
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Name | MELISSA GAVINA
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Credential |
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Telephone | 847-891-6850
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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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