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General NPI Number Information
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NPI Number | 1659508356
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Entity Type | Organization
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Legal Business Name | PRIMECARE MEDICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 7114 S VINCENNES AVE
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City | CHICAGO
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State | IL
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Zip | 60621-3506
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Country | US
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Telephone | 773-224-4800
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Fax | 847-890-6660
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Provider Business Mailing Address
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Address Line | 1375 E SCHAUMBURG RD SUITE 100
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City | SCHAUMBURG
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State | IL
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Zip | 60194-5166
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Country | US
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Telephone | 847-891-6850
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Fax | 630-339-5803
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MIRZA BAIG
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Credential |
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Telephone | 773-224-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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