Organization
FAMILY MEDICAL ASSOCIATES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHITAL PATEL (PATIENT ACCOUNT REPRESENTATIVE)
(630) 467-0101
Entity
Organization
Contact information
Practice address
1107 N. PROSPECT AVE, SUITE 100, ITASCA, IL 60143-1408
(630) 467-0101
(630) 467-0707
Mailing address
1107 N. PROSPECT AVE, SUITE 100, ITASCA, IL 60143-1408
(630) 467-0101
(630) 467-0707
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1623802
BCBS PROVIDER NUMBER
IL
01
—
P00403792
RAILROAD MEDICARE
IL
Enumeration date
10/31/2006
Last updated
11/10/2010
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