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General NPI Number Information
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NPI Number | 1427599976
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Entity Type | Organization
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Legal Business Name | ICZ MEDICAL GROUP
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 5532 N MILWAUKEE AVE SUITE # B
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City | CHICAGO
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State | IL
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Zip | 60630-1271
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Country | US
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Telephone | 847-845-5998
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Fax | 224-404-4901
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Provider Business Mailing Address
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Address Line | 5532 N MILWAUKEE AVE SUITE # B
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City | CHICAGO
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State | IL
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Zip | 60630-1271
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Country | US
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Telephone | 847-845-5998
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Fax | 224-404-4901
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CHIMGEE BATUU
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Credential | DN
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Telephone | 847-845-5998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203001895
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License Number State | IL
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