# BROADWAY MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306952858
- **Authorized official:** K.J. J PHILIP MD (OWNER)
- **Authorized official phone:** (847) 475-6063

## Contact information

- **Practice address:** 4826 N. BROADWAY, CHICAGO, IL 60640
- **Practice address phone:** (773) 275-8333
- **Practice address fax:** (773) 275-9297
- **Mailing address:** 4826 N BROADWAY ST, CHICAGO, IL 60640-3604
- **Mailing address phone:** (773) 275-8333
- **Mailing address fax:** (773) 275-9297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 173000000X | Legal Medicine | 036110420 | IL | Yes |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 04/13/2010