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NPI Code Detail

MEDICARE: TRI CARE MEDICAL GROUP LLC

MEDICARE: TRI CARE 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
1261QU0200XUrgent Care Clinic/Center
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1598081333
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI CARE MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 1375 E SCHAUMBURG RD
Second Line : STE 100
City : SCHAUMBURG
State : IL
Zip : 60194-5166
Country : US
Telephone Number : 847-891-6850
Fax Number : 630-339-5803
Provider Business Practice Location Address
First Line : 4332 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-2144
Country : US
Telephone Number : 847-891-6850
Fax Number : 630-339-5803
Authorized Official
Title or Position : PRESIDENT
Name : MR. MOHAMMAD AZHARUDDIN
Credential :
Telephone Number : 847-891-6850
Provider Enumeration Date : 04/19/2010
Last Update Date : 04/20/2010

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Directions to “TRI CARE MEDICAL GROUP LLC ” Practice Location

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