Organization
CERMAK MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUCHIR THAKKAR D.O. (MEDICAL DIRECTOR)
(708) 222-0100
Entity
Organization
Contact information
Practice address
5741 W CERMAK RD, CICERO, IL 60804-2129
(708) 222-0100
(708) 222-0102
Mailing address
5741 W CERMAK RD, CICERO, IL 60804-2129
(708) 222-0100
(708) 222-0102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036133879
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036133879
—
IL
Enumeration date
03/23/2017
Last updated
01/25/2019
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