Provider Demographics
NPI:1609018720
Name:THE ARLINGTON MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:THE ARLINGTON MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIST
Authorized Official - Middle Name:
Authorized Official - Last Name:KOULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-371-2140
Mailing Address - Street 1:1925 E RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4366
Mailing Address - Country:US
Mailing Address - Phone:847-253-3300
Mailing Address - Fax:847-398-6508
Practice Address - Street 1:1925 E RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4366
Practice Address - Country:US
Practice Address - Phone:847-253-3300
Practice Address - Fax:847-398-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center