MEDICARE: PROGRESSIVE MEDICAL CENTER SC

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	036103673	IL
2	208000000X	Pediatrics Physician	036078267	IL
3	207R00000X	Internal Medicine Physician	036087152	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	02205538	OTHER	IL	BCBS GROUP NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851464549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE MEDICAL CENTER SC

Provider Business Mailing Address
First Line	:	229 W GRAND AVENUE
Second Line	:	SUITE R
City	:	BENSENVILLE
State	:	IL
Zip	:	60106-3365
Country	:	US
Telephone Number	:	630-238-9235
Fax Number	:	630-238-0426

Provider Business Practice Location Address
First Line	:	1841 W ARMY TRAIL RD
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1901
Country	:	US
Telephone Number	:	630-238-9235
Fax Number	:	630-238-0426

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GABRIELA HENRIQUEZ
Credential	:
Telephone Number	:	630-238-9235

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	08/02/2024

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Directions to “PROGRESSIVE MEDICAL CENTER SC ” Practice Location

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