Organization
INTENSIVIST GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY S COWEN MD (PRESIDENT OWNER)
(866) 344-0543
Entity
Organization
Contact information
Practice address
800 W CENTRAL ROAD, ARLINGTON HEIGHTS, IL 60005
(866) 540-5303
Mailing address
DEPT 4392, CAROL STREAM, IL 60122-4392
(866) 540-5303
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004932462
BLUE SHIELD IL
IL
Enumeration date
05/08/2006
Last updated
06/20/2011
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