Provider Demographics
NPI:1386660033
Name:CPMG-MA, LLC
Entity Type:Organization
Organization Name:CPMG-MA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KONOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-921-9733
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-470-8740
Mailing Address - Fax:847-470-8750
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-470-8740
Practice Address - Fax:847-470-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623704OtherBCBSIL
IL1623704OtherBCBSIL
IL585400Medicare ID - Type Unspecified