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General NPI Number Information
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NPI Number | 1467626168
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Entity Type | Organization
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Legal Business Name | REGINALD SPEARS MD LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 4160 ROUTE 83 SUITE 207
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-415-2127
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Fax | 847-415-2130
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Provider Business Mailing Address
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Address Line | 4160 ROUTE 83 SUITE 207
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-415-2127
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Fax | 847-415-2130
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Authorized Official
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Title or Position | OWNER
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Name | DR. REGINALD SPEARS
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Credential | M.D.
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Telephone | 847-415-2127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | IL
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