MEDICARE: CERMAK MEDICAL GROUP LLC

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	207Q00000X	Family Medicine Physician	036133879	IL

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	:	1518498393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERMAK MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	5741 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2129
Country	:	US
Telephone Number	:	708-222-0100
Fax Number	:	708-222-0102

Provider Business Practice Location Address
First Line	:	5741 W CERMAK RD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2129
Country	:	US
Telephone Number	:	708-222-0100
Fax Number	:	708-222-0102

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RUCHIR THAKKAR
Credential	:	D.O.
Telephone Number	:	708-222-0100

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	01/25/2019

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Directions to “CERMAK MEDICAL GROUP LLC ” Practice Location

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