Provider Demographics
NPI:1366861304
Name:CHICAGOLAND INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:CHICAGOLAND INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-229-2013
Mailing Address - Street 1:117 S COOK ST
Mailing Address - Street 2:SUITE 195
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4311
Mailing Address - Country:US
Mailing Address - Phone:480-229-2013
Mailing Address - Fax:480-718-7635
Practice Address - Street 1:117 S COOK ST
Practice Address - Street 2:SUITE 195
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4311
Practice Address - Country:US
Practice Address - Phone:480-229-2013
Practice Address - Fax:480-718-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty