Provider Demographics
NPI:1467577874
Name:MPFERGUS, SC
Entity Type:Organization
Organization Name:MPFERGUS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERGUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-253-8814
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0986
Mailing Address - Country:US
Mailing Address - Phone:630-253-8814
Mailing Address - Fax:815-230-2608
Practice Address - Street 1:13025 CONIFER ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2989
Practice Address - Country:US
Practice Address - Phone:630-253-8814
Practice Address - Fax:815-230-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.618333261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932261OtherBCBS
IL9932261OtherBCBS
ILU99794Medicare UPIN