Provider Demographics
NPI:1164667580
Name:PRIVATE PHYSICIAN PLACEMENTS LLC
Entity Type:Organization
Organization Name:PRIVATE PHYSICIAN PLACEMENTS LLC
Other - Org Name:THE GALERA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GALERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-589-5010
Mailing Address - Street 1:17W300 22ND ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4405
Mailing Address - Country:US
Mailing Address - Phone:630-589-5010
Mailing Address - Fax:630-589-5011
Practice Address - Street 1:17W300 22ND ST
Practice Address - Street 2:SUITE 320
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4405
Practice Address - Country:US
Practice Address - Phone:630-589-5010
Practice Address - Fax:630-589-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty