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General NPI Number Information
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NPI Number | 1467745430
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Entity Type | Organization
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Legal Business Name | MD MEDICAL GROUP, S.C.
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 15 SPINNING WHEEL RD STE 210
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City | HINSDALE
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State | IL
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Zip | 60521-2984
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Country | US
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Telephone | 312-402-2962
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Fax | 312-842-8521
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Provider Business Mailing Address
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Address Line | PO BOX 5652
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City | CHICAGO
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State | IL
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Zip | 60680-5652
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Country | US
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Telephone | 312-842-8505
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Fax | 312-842-8521
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE L DEES
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Credential | M.D.
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Telephone | 312-402-2962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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