Provider Demographics
NPI:1154305852
Name:MACOMB INTERNAL MEDICINE LTD
Entity Type:Organization
Organization Name:MACOMB INTERNAL MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:REEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-837-9926
Mailing Address - Street 1:515 E GRANT ST
Mailing Address - Street 2:STE 111
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3315
Mailing Address - Country:US
Mailing Address - Phone:309-837-9926
Mailing Address - Fax:309-833-1417
Practice Address - Street 1:515 E GRANT ST
Practice Address - Street 2:STE 111
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3315
Practice Address - Country:US
Practice Address - Phone:309-837-9926
Practice Address - Fax:309-833-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05532012OtherBCBS OF ILLINOIS
IL05532012OtherBCBS OF ILLINOIS