Provider Demographics
NPI:1033485818
Name:EXECUTIVE HEALTH GROUP OF ILLINOIS, SC
Entity Type:Organization
Organization Name:EXECUTIVE HEALTH GROUP OF ILLINOIS, SC
Other - Org Name:EHE INTERNATIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROPERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-332-3725
Mailing Address - Street 1:10 ROCKEFELLER PLZ FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-1903
Mailing Address - Country:US
Mailing Address - Phone:212-332-3700
Mailing Address - Fax:
Practice Address - Street 1:181 W MADISON ST STE 4550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4636
Practice Address - Country:US
Practice Address - Phone:312-341-2586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty