Provider Demographics
NPI:1437584364
Name:PREMIERE GENERAL MEDICINE S C
Entity Type:Organization
Organization Name:PREMIERE GENERAL MEDICINE S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-334-7929
Mailing Address - Street 1:207 E OHIO ST STE 252
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3238
Mailing Address - Country:US
Mailing Address - Phone:708-334-7929
Mailing Address - Fax:708-293-8789
Practice Address - Street 1:7600 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1001
Practice Address - Country:US
Practice Address - Phone:708-334-7929
Practice Address - Fax:708-293-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669447272OtherNPI, INDIVIDUAL
ILG46997Medicare UPIN