1437389475 NPI number — FAMILY MEDICINE SPECIALISTS OF MOUNT PROSPECT S C

Table of content: JAYNE MILLMAN APRN (NPI 1083235196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437389475 NPI number — FAMILY MEDICINE SPECIALISTS OF MOUNT PROSPECT S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY MEDICINE SPECIALISTS OF MOUNT PROSPECT S C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY MEDICINE SPECIALISTS OF MOUNT PROSPECT INCORPORATED
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437389475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6037
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUCONDA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60084-2452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-526-2151
Provider Business Mailing Address Fax Number:
847-526-2017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 MOUNT PROSPECT PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PROSPECT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60056-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-797-1962
Provider Business Practice Location Address Fax Number:
847-797-1972
Provider Enumeration Date:
07/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BELLUCCI
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
847-526-2151

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036083207 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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