Provider Demographics
NPI:1558541862
Name:ENDOCRINE MEDICAL SPECIALISTS, SC
Entity Type:Organization
Organization Name:ENDOCRINE MEDICAL SPECIALISTS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-699-1900
Mailing Address - Street 1:9101 N GREENWOOD AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1499
Mailing Address - Country:US
Mailing Address - Phone:847-699-1900
Mailing Address - Fax:847-699-1925
Practice Address - Street 1:9101 N GREENWOOD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1499
Practice Address - Country:US
Practice Address - Phone:847-699-1900
Practice Address - Fax:847-699-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075285261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075285Medicaid
ILE30846Medicare UPIN