Provider Demographics
NPI:1659307874
Name:ELK GROVE INTERNISTS, P.C.
Entity Type:Organization
Organization Name:ELK GROVE INTERNISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-981-8856
Mailing Address - Street 1:810 BIESTERFIELD RD
Mailing Address - Street 2:SUITE G4
Mailing Address - City:ELK GROVE VLG
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 BIESTERFIELD RD
Practice Address - Street 2:SUITE G4
Practice Address - City:ELK GROVE VLG
Practice Address - State:IL
Practice Address - Zip Code:60007-7312
Practice Address - Country:US
Practice Address - Phone:847-981-8856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
624830Medicare PIN