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Organization
PRIME MEDICAL CLINIC S.C.
Active
Organization
PRIME MEDICAL CLINIC S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KONSTANTINS KOCIASVILI MD (MEDICAL DOCTOR)
(773) 507-7434
Entity
Organization
Contact information
Practice address
3633 W LAKE AVE STE 307, GLENVIEW, IL 60026-5803
(847) 626-8722
(847) 316-9502
Mailing address
333 W DUNDEE RD, BUFFALO GROVE, IL 60089-3545
(847) 243-0355
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
036135325
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036135325
—
IL
Enumeration date
12/05/2016
Last updated
01/13/2023
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