Organization
PRIME HEALTHCARE ILLINOIS MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (MANAGING ASSOCIATE GENERAL COUNSEL)
(310) 259-4706
Entity
Organization
Contact information
Practice address
2380 E DEMPSTER ST, DES PLAINES, IL 60016-4839
(833) 291-0464
Mailing address
2380 E DEMPSTER ST, DES PLAINES, IL 60016-4839
(833) 291-0464
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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