Provider Demographics
NPI:1467677948
Name:GURNEE PHYSICAL MEDICINE LTD
Entity Type:Organization
Organization Name:GURNEE PHYSICAL MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEELESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:847-336-4444
Mailing Address - Street 1:5415 W. GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-336-4444
Mailing Address - Fax:847-336-4446
Practice Address - Street 1:5415 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4906
Practice Address - Country:US
Practice Address - Phone:847-336-4444
Practice Address - Fax:847-336-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty