Provider Demographics
NPI:1639204472
Name:PRIMECARE FAMILY PHYSICIANS, LTD
Entity Type:Organization
Organization Name:PRIMECARE FAMILY PHYSICIANS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-625-1900
Mailing Address - Street 1:7400 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3418
Mailing Address - Country:US
Mailing Address - Phone:773-625-1900
Mailing Address - Fax:773-625-5348
Practice Address - Street 1:7400 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3418
Practice Address - Country:US
Practice Address - Phone:773-625-1900
Practice Address - Fax:773-625-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN4562OtherRAILROAD MEDICARE
281500Medicare PIN