Provider Demographics
NPI:1255320271
Name:CLAYMORE MEDICAL GROUP SC
Entity Type:Organization
Organization Name:CLAYMORE MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-223-4446
Mailing Address - Street 1:1170 E BELVIDERE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2061
Mailing Address - Country:US
Mailing Address - Phone:847-223-4446
Mailing Address - Fax:847-223-4944
Practice Address - Street 1:1170 E BELVIDERE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2061
Practice Address - Country:US
Practice Address - Phone:847-223-4446
Practice Address - Fax:847-223-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty