Provider Demographics
NPI:1518290410
Name:ILLINOIS HOSPITALIST GROUP INC
Entity Type:Organization
Organization Name:ILLINOIS HOSPITALIST GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:RATHINAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-837-2345
Mailing Address - Street 1:10554 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1934
Mailing Address - Country:US
Mailing Address - Phone:708-837-2345
Mailing Address - Fax:
Practice Address - Street 1:10554 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1934
Practice Address - Country:US
Practice Address - Phone:708-837-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.079917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN