Provider Demographics
NPI:1407044225
Name:JOHN G. SCARAMELLA, M.D.,S.C.
Entity Type:Organization
Organization Name:JOHN G. SCARAMELLA, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCARAMELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-202-5959
Mailing Address - Street 1:PO BOX 7389
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-7389
Mailing Address - Country:US
Mailing Address - Phone:773-202-5959
Mailing Address - Fax:773-202-9144
Practice Address - Street 1:4920 N CENTRAL AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2338
Practice Address - Country:US
Practice Address - Phone:773-202-5959
Practice Address - Fax:773-202-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL519010Medicare PIN
ILF34613Medicare UPIN