Provider Demographics
NPI:1043237969
Name:CONCOURSE MEDICAL ASSOCIATES, LTD
Entity Type:Organization
Organization Name:CONCOURSE MEDICAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KLEMPTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-583-0939
Mailing Address - Street 1:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-4600
Mailing Address - Fax:773-767-8320
Practice Address - Street 1:5410 WARREN ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3639
Practice Address - Country:US
Practice Address - Phone:847-583-0939
Practice Address - Fax:847-583-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036026661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036026661Medicaid
IL01607179OtherBLUE SHIELD
P00134710OtherRAILROAD MEDICARE
IL036026661Medicaid