Provider Demographics
NPI:1467465492
Name:FOCUS INTERNAL MEDICINE, SC
Entity Type:Organization
Organization Name:FOCUS INTERNAL MEDICINE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-285-1530
Mailing Address - Street 1:460 BRIARGATE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2227
Mailing Address - Country:US
Mailing Address - Phone:847-697-9100
Mailing Address - Fax:847-697-5105
Practice Address - Street 1:460 BRIARGATE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2227
Practice Address - Country:US
Practice Address - Phone:847-697-9100
Practice Address - Fax:847-697-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208243Medicare ID - Type UnspecifiedMCR GROUP#