# IMPACT PHYSICIAN GROUP, ILLINOIS LLC

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

## Provider details

- **NPI number:** 1467920124
- **Authorized official:** MR. PAUL MILLER (CEO)
- **Authorized official phone:** (678) 967-5599

## Contact information

- **Practice address:** 115 E SOUTH ST STE F, PLANO, IL 60545-1595
- **Practice address phone:** (630) 552-7166
- **Mailing address:** 21 EASTBROOK BND STE 218, PEACHTREE CITY, GA 30269-1546
- **Mailing address phone:** (678) 967-5599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 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