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General NPI Number Information
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NPI Number | 1215528922
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Entity Type | Organization
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Legal Business Name | TT MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 741 S MCHENRY AVE STE C&D
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7445
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Country | US
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Telephone | 815-770-2780
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Fax | 815-770-2780
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Provider Business Mailing Address
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Address Line | 741 S MCHENRY AVE STE C&D
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7445
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Country | US
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Telephone | 815-770-2780
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Fax | 815-770-2780
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Authorized Official
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Title or Position | PARTNER
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Name | RUCHIR THAKKAR
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Credential | DO
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Telephone | 847-322-7149
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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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