MEDICARE: PHYSICIANS OF INTERNAL MEDICINE AND PEDIATRICS

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	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1891562443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS OF INTERNAL MEDICINE AND PEDIATRICS

Provider Business Mailing Address
First Line	:	360 W BUTTERFIELD RD STE 270
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-5098
Country	:	US
Telephone Number	:	630-523-9161
Fax Number	:	630-523-9697

Provider Business Practice Location Address
First Line	:	360 W BUTTERFIELD RD STE 270
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-5098
Country	:	US
Telephone Number	:	630-523-9161
Fax Number	:	630-523-9697

Authorized Official
Title or Position	:	OWNER
Name	:	BHAVYA KUMAR
Credential	:	MD
Telephone Number	:	630-523-9161

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	08/14/2024

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