Provider Demographics
NPI:1073243911
Name:HALCYON MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HALCYON MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-394-0571
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-0561
Mailing Address - Country:US
Mailing Address - Phone:312-394-0571
Mailing Address - Fax:
Practice Address - Street 1:6241 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1909
Practice Address - Country:US
Practice Address - Phone:312-394-0571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty