Provider Demographics
NPI:1497763486
Name:CONSULTANTS OF INTERNAL MEDICINE LTD
Entity Type:Organization
Organization Name:CONSULTANTS OF INTERNAL MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEH-WENG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-895-0555
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-0117
Mailing Address - Country:US
Mailing Address - Phone:815-895-0555
Mailing Address - Fax:815-895-7555
Practice Address - Street 1:1711 DEKALB AVENUE
Practice Address - Street 2:SUITE C4
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-895-0555
Practice Address - Fax:815-895-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211211Medicare PIN
ILK15673Medicare PIN