Provider Demographics
NPI:1659683373
Name:H & M MEDICAL, SC
Entity Type:Organization
Organization Name:H & M MEDICAL, SC
Other - Org Name:CENTRO MEDICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-797-4433
Mailing Address - Street 1:5103 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2902
Mailing Address - Country:US
Mailing Address - Phone:708-780-1280
Mailing Address - Fax:708-780-1237
Practice Address - Street 1:3633 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2344
Practice Address - Country:US
Practice Address - Phone:773-772-6630
Practice Address - Fax:773-772-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010477208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty