Provider Demographics
NPI:1417188954
Name:PRIMECARE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL ASSOCIATES
Other - Org Name:ENGLEWOOD IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-744-7864
Mailing Address - Street 1:1375 E SCHAUMBURG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3643
Mailing Address - Country:US
Mailing Address - Phone:773-744-7864
Mailing Address - Fax:847-890-6660
Practice Address - Street 1:7114 S VINCENNES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3506
Practice Address - Country:US
Practice Address - Phone:773-224-4800
Practice Address - Fax:847-890-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty