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NPI Code Detail

MEDICARE: STREETERVILLE INTERNAL MEDICINE, PLLC

MEDICARE: STREETERVILLE INTERNAL MEDICINE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036113766IL

General Provider Information

NPI Number : 1205139730
Entity Type Code : Organization
Provider Name (Legal Business Name) : STREETERVILLE INTERNAL MEDICINE, PLLC
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 1740
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2963
Country : US
Telephone Number : 312-926-0444
Fax Number : 312-926-0444
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 1740
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2963
Country : US
Telephone Number : 312-926-0444
Fax Number : 312-926-0444
Authorized Official
Title or Position : OWNER
Name : DR. RACHEL ANNE O'MARA
Credential : MD
Telephone Number : 312-926-0444
Provider Enumeration Date : 12/05/2010
Last Update Date : 01/13/2021

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Directions to “STREETERVILLE INTERNAL MEDICINE, PLLC ” Practice Location

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