# FIDAI MEDICAL GROUP

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

## Provider details

- **NPI number:** 1568450054
- **Authorized official:** SHAZLEEN VARGAS (OFFICE MANAGER)
- **Authorized official phone:** (847) 741-9800

## Contact information

- **Practice address:** 1710 N RANDALL RD, \#380, ELGIN, IL 60123-9400
- **Practice address phone:** (847) 741-9800
- **Practice address fax:** (847) 741-3058
- **Mailing address:** 1710 N RANDALL RD, \#380, ELGIN, IL 60123-9400
- **Mailing address phone:** (847) 741-9800
- **Mailing address fax:** (847) 741-3058

## Taxonomy

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

## Other

- **Enumeration date:** 10/10/2005
- **Last updated:** 08/22/2020