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Organization
IMPACT PHYSICIAN GROUP, ILLINOIS LLC
Active
Organization
IMPACT PHYSICIAN GROUP, ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL MILLER (CEO)
(678) 967-5599
Entity
Organization
Contact information
Practice address
115 E SOUTH ST STE F, PLANO, IL 60545-1595
(630) 552-7166
Mailing address
21 EASTBROOK BND STE 218, PEACHTREE CITY, GA 30269-1546
(678) 967-5599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
Other
Enumeration date
11/10/2018
Last updated
12/19/2022
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