Provider Demographics
NPI:1659569903
Name:SUMMIT HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUMMIT HEALTHCARE LLC
Other - Org Name:WESTWOOD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRAKAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-935-2817
Mailing Address - Street 1:2235 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4828
Mailing Address - Country:US
Mailing Address - Phone:773-762-2573
Mailing Address - Fax:
Practice Address - Street 1:2235 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4828
Practice Address - Country:US
Practice Address - Phone:773-762-2573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH47161Medicare UPIN
ILC45250Medicare UPIN