Provider Demographics
NPI:1508854969
Name:CMBY CLINIC, LTD.
Entity Type:Organization
Organization Name:CMBY CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-832-6633
Mailing Address - Street 1:135 S COTTAGE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3330
Mailing Address - Country:US
Mailing Address - Phone:630-832-6633
Mailing Address - Fax:630-832-6653
Practice Address - Street 1:135 S COTTAGE HILL AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3330
Practice Address - Country:US
Practice Address - Phone:630-832-6633
Practice Address - Fax:630-832-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42003094261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212296Medicare ID - Type Unspecified