Provider Demographics
NPI:1285823955
Name:INTEGRATED HEALTH CENTER S.C.
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BORRASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-886-8037
Mailing Address - Street 1:15 WEST 720 89TH STREET
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2783
Mailing Address - Country:US
Mailing Address - Phone:815-886-8037
Mailing Address - Fax:815-886-3392
Practice Address - Street 1:15 WEST 720 89TH ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2783
Practice Address - Country:US
Practice Address - Phone:815-886-8037
Practice Address - Fax:815-886-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
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
IL335300Medicare PIN