Provider Demographics
NPI:1003235979
Name:MEDCARE MEDICAL GROUP
Entity Type:Organization
Organization Name:MEDCARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:847-724-7600
Mailing Address - Street 1:1873 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2158
Mailing Address - Country:US
Mailing Address - Phone:847-724-7600
Mailing Address - Fax:847-724-7693
Practice Address - Street 1:1873 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2158
Practice Address - Country:US
Practice Address - Phone:847-724-7600
Practice Address - Fax:847-724-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0070006734225100000X
IL0056000758225X00000X
IL146009200235Z00000X
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty