Organization
I2 MEDICINE LLC
Active
Other names
I-Squared Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIC D PATAWARAN MD (CO-OWNER)
(773) 490-5611
Entity
Organization
Contact information
Practice address
1100 LAKE ST STE 125, OAK PARK, IL 60301-6702
(773) 490-5611
(312) 276-8684
Mailing address
PO BOX 25816, CHICAGO, IL 60625-8616
(773) 490-5611
(312) 276-8684
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036899826
LICENSE
IL
Enumeration date
07/15/2019
Last updated
07/15/2019
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