Provider Demographics
NPI:1518180686
Name:ASSOCIATED MEDICAL CENTERS OF ILLINOIS, LTD.
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL CENTERS OF ILLINOIS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-947-7746
Mailing Address - Street 1:2656 W MONTROSE
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:773-267-1304
Mailing Address - Fax:773-267-1307
Practice Address - Street 1:2656 W MONTROSE
Practice Address - Street 2:STE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-267-1304
Practice Address - Fax:773-267-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty