Provider Demographics
NPI:1225286412
Name:MSMC INVESTORS, LLC
Entity Type:Organization
Organization Name:MSMC INVESTORS, LLC
Other - Org Name:D/B/A METRO SOUTH MEDICAL CENTER PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN DETAILER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WCISLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-597-2000
Mailing Address - Street 1:P.O. BOX 2753
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-2753
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:708-824-4505
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:708-824-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099296207Q00000X
IL036106823207Q00000X
IL036118421207Q00000X
IL036123124207Q00000X
IL036110076207V00000X
IL036117162207V00000X
IL036089662207V00000X
IL036116768207V00000X
IL036058336207V00000X
IL036044194207V00000X
IL036112780207V00000X
IL036065557207V00000X
IL036068845207V00000X
IL036045416207V00000X
IL209003023367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001628587OtherBC/BS