Provider Demographics
NPI:1437541000
Name:PREMIERE FAMILY HEALTH INC
Entity Type:Organization
Organization Name:PREMIERE FAMILY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-200-6615
Mailing Address - Street 1:5600 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2902
Mailing Address - Country:US
Mailing Address - Phone:708-952-0000
Mailing Address - Fax:708-529-7195
Practice Address - Street 1:5600 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2902
Practice Address - Country:US
Practice Address - Phone:708-952-0000
Practice Address - Fax:708-529-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119432Medicaid