Provider Demographics
NPI:1609297266
Name:ULTIMATE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:ULTIMATE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-817-6000
Mailing Address - Street 1:3590 HOBSON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-5409
Mailing Address - Country:US
Mailing Address - Phone:630-778-9000
Mailing Address - Fax:630-778-9065
Practice Address - Street 1:3590 HOBSON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-5409
Practice Address - Country:US
Practice Address - Phone:630-778-9000
Practice Address - Fax:630-778-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006843111N00000X
IL03607713207P00000X
IL036134622207Q00000X
IL036089214208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty