Provider Demographics
NPI:1053300699
Name:THE ELGIN CLINIC LTD
Entity Type:Organization
Organization Name:THE ELGIN CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAHIDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-697-7598
Mailing Address - Street 1:1530 N RANDALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7877
Mailing Address - Country:US
Mailing Address - Phone:847-697-6464
Mailing Address - Fax:847-697-6478
Practice Address - Street 1:1530 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7877
Practice Address - Country:US
Practice Address - Phone:847-697-6464
Practice Address - Fax:847-697-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210145Medicare PIN
IL909651Medicare PIN
IL909650Medicare PIN