Provider Demographics
NPI:1194229971
Name:REMEDY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:REMEDY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BARNO
Authorized Official - Middle Name:
Authorized Official - Last Name:KADYROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-848-0552
Mailing Address - Street 1:222 E DUNDEE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 E DUNDEE RD FL 2
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3009
Practice Address - Country:US
Practice Address - Phone:224-848-0552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid