Organization
ILLINOIS MEDICAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARMED G ELIAS M.D. (PRESIDENT)
(773) 545-6900
Entity
Organization
Contact information
Practice address
4211 N CICERO AVE, CHICAGO, IL 60641-1651
(773) 545-6900
(773) 685-2481
Mailing address
4211 N CICERO AVE, CHICAGO, IL 60641-1651
(773) 545-6900
(773) 685-2481
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
042618822
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG1734
MEDICARE RAILROAD
IL
Enumeration date
06/04/2006
Last updated
06/12/2008
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