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General NPI Number Information
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NPI Number | 1912473604
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PHYSICIANS OF JOLIET SC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 2025 S CHICAGO ST STE 1
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City | JOLIET
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State | IL
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Zip | 60436-3173
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Country | US
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Telephone | 815-726-2200
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Fax | 815-582-3253
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Provider Business Mailing Address
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Address Line | 2025 S CHICAGO ST STE 1
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City | JOLIET
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State | IL
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Zip | 60436-3173
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Country | US
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Telephone | 815-726-2200
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Fax | 815-582-3253
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MITI G SHAH
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Credential |
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Telephone | 815-726-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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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 |
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Taxonomy #3
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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 |
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