Provider Demographics
NPI:1477549038
Name:INTERNAL MEDICINE ASSOCIATES SC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HESHIZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-462-5100
Mailing Address - Street 1:912 NORTHWEST HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1925
Mailing Address - Country:US
Mailing Address - Phone:847-462-5100
Mailing Address - Fax:847-462-5101
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-462-5100
Practice Address - Fax:847-462-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
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
678712Medicare ID - Type Unspecified