MEDICARE: SUMMIT MEDICAL CARE, 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		IL

General Provider Information

NPI Number	:	1811944788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT MEDICAL CARE, LLC

Provider Business Mailing Address
First Line	:	640 S WASHINGTON ST
Second Line	:	SUITE 110
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6603
Country	:	US
Telephone Number	:	331-457-5737
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 S WASHINGTON ST
Second Line	:	SUITE 110
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6603
Country	:	US
Telephone Number	:	331-457-5737
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. COSME CRUZ
Credential	:	MD
Telephone Number	:	312-505-3830

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/21/2022

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