Provider Demographics
NPI:1659327179
Name:PRIMARY CARE NORTH, SC
Entity Type:Organization
Organization Name:PRIMARY CARE NORTH, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-391-9944
Mailing Address - Street 1:150 N RIVER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1272
Mailing Address - Country:US
Mailing Address - Phone:847-391-9944
Mailing Address - Fax:847-391-9955
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-391-9944
Practice Address - Fax:847-391-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623420OtherBLUE CROSS & BLUE SHIELD
IL572740Medicare ID - Type Unspecified