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NPI Code Detail

MEDICARE: PIERSON MEDICAL GROUP INC

MEDICARE: PIERSON MEDICAL GROUP INC
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
1174400000XSpecialist036088112IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
201634224OTHERILBC/BS PROVIDER #

General Provider Information

NPI Number : 1932115755
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIERSON MEDICAL GROUP INC
Provider Business Mailing Address
First Line : 1477 RING RD
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5459
Country : US
Telephone Number : 708-868-3309
Fax Number : 708-868-3321
Provider Business Practice Location Address
First Line : 1477 RING RD
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5459
Country : US
Telephone Number : 708-868-3309
Fax Number : 708-868-3321
Authorized Official
Title or Position : OWNER
Name : JANICE PIERSON
Credential : MD
Telephone Number : 708-868-3309
Provider Enumeration Date : 08/01/2006
Last Update Date : 05/14/2013

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Directions to “PIERSON MEDICAL GROUP INC ” Practice Location

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