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Organization
PRIME HEALTHCARE ILLINOIS MEDICAL GROUP LLC
Active
Organization
PRIME HEALTHCARE ILLINOIS MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (MANAGING ASSOCIATE GENERAL COUNSEL)
(310) 259-4706
Entity
Organization
Contact information
Practice address
2380 E DEMPSTER ST, DES PLAINES, IL 60016-4839
(833) 291-0464
Mailing address
2380 E DEMPSTER ST, DES PLAINES, IL 60016-4839
(833) 291-0464
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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