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General NPI Number Information
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NPI Number | 1639375637
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DEVON MEDICAL CENTER
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 342 SOUTH MILWAUKEE AVE.
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City | WHEELING
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State | IL
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Zip | 60090
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Country | US
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Telephone | 847-520-8909
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Fax | 847-520-8929
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Provider Business Mailing Address
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Address Line | 342 SOUTH MILWAUKEE AVE.
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City | WHEELING
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State | IL
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Zip | 60090
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Country | US
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Telephone | 847-520-8909
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Fax | 847-520-8929
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BORIS GUREVICH
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Credential | M.D.
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Telephone | 847-520-8909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | IL
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Taxonomy #2
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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 | IL
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Taxonomy #3
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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 | IL
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Taxonomy #4
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | IL
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Taxonomy #6
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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 | IL
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Taxonomy #7
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | IL
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