Provider Demographics
NPI:1114249125
Name:PRIMARY CARE OF ILLINOIS, SC
Entity Type:Organization
Organization Name:PRIMARY CARE OF ILLINOIS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-768-9300
Mailing Address - Street 1:1550 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1411
Mailing Address - Country:US
Mailing Address - Phone:847-768-9300
Mailing Address - Fax:847-768-9393
Practice Address - Street 1:1550 N NORTHWEST HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1411
Practice Address - Country:US
Practice Address - Phone:847-768-9300
Practice Address - Fax:847-768-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty