MEDICARE: PRESENCE HEALTHCARE SERVICES PRESENCE MEDICAL GROUP

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
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285741033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESENCE HEALTHCARE SERVICES PRESENCE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1000 REMINGTON BOULEVARD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-0000
Country	:	US
Telephone Number	:	630-914-2417
Fax Number	:	630-914-2499

Provider Business Practice Location Address
First Line	:	4833 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2145
Country	:	US
Telephone Number	:	773-205-2857
Fax Number	:	708-205-4380

Authorized Official
Title or Position	:	CEO
Name	:	REINHOLD LLERENA
Credential	:	MD
Telephone Number	:	224-273-8908

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/08/2021

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