Provider Demographics
NPI:1285854067
Name:GREAT HEIGHTS FAMILY MEDICINE LTD.
Entity Type:Organization
Organization Name:GREAT HEIGHTS FAMILY MEDICINE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEYEMI
Authorized Official - Middle Name:OLUDARE
Authorized Official - Last Name:FATOKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-862-8156
Mailing Address - Street 1:1473 RING RD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5459
Mailing Address - Country:US
Mailing Address - Phone:312-952-9378
Mailing Address - Fax:708-862-8105
Practice Address - Street 1:1473 RING RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5459
Practice Address - Country:US
Practice Address - Phone:312-952-9378
Practice Address - Fax:708-862-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL65528584207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100356658Medicare PIN
IL215229Medicare PIN