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General NPI Number Information
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NPI Number | 1396573366
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Entity Type | Organization
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Legal Business Name | PREMIER OCCUPATIONAL HEALTH AT MIDWEST PLLC
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 300 W BUTTERFIELD RD
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City | ELMHURST
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State | IL
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Zip | 60126-5017
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Country | US
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Telephone | 630-972-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W BUTTERFIELD RD
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City | ELMHURST
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State | IL
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Zip | 60126-5017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANATOLY GOROVITS
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Credential | MD
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Telephone | 630-972-0733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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