Organization
PRAIRIE GLEN PRIMARY CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILAH MARIE HELLER-BAIR MD (OWNER)
(630) 257-5400
Entity
Organization
Contact information
Practice address
15505 127TH ST, LEMONT, IL 60439-4433
(630) 257-5400
(630) 257-1954
Mailing address
15505 127TH ST, LEMONT, IL 60439-4433
(630) 257-5400
(630) 257-1954
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036110756
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634883
BLUE CROSS BLUE SHIELD O
IL
05
—
036110756
—
IL
01
—
276
SILVER CROSS MANAGED CARE
IL
01
—
5936374
AETNA
IL
01
—
6599328
CIGNA
IL
Enumeration date
01/02/2007
Last updated
09/27/2011
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