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General NPI Number Information
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NPI Number | 1174459937
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Entity Type | Organization
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Legal Business Name | PROMED PREFERRED IL 4 PLLC
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Dates
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Enumeration Date | 06/19/2026
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Last Update Date | 06/19/2026
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Provider Practice Location Address
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Address Line | 1449 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-1922
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Country | US
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Telephone | 872-315-3375
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Fax | 855-654-6385
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Provider Business Mailing Address
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Address Line | 1449 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-1922
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Country | US
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Telephone | 872-315-3375
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Fax | 855-654-6385
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Authorized Official
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Title or Position | MANAGER
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Name | MR. LAUREN DUANE BUCKINGHAM
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Credential | PA-C
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Telephone | 616-325-5039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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