Provider Demographics
NPI:1598081333
Name:TRI CARE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:TRI CARE MEDICAL GROUP LLC
Other - Org Name:NORTHWEST IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AZHARUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-891-6850
Mailing Address - Street 1:1375 E SCHAUMBURG RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-5166
Mailing Address - Country:US
Mailing Address - Phone:847-891-6850
Mailing Address - Fax:630-339-5803
Practice Address - Street 1:4332 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2144
Practice Address - Country:US
Practice Address - Phone:847-891-6850
Practice Address - Fax:630-339-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty