Provider Demographics
NPI:1659874261
Name:RELIVE PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:RELIVE PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-227-4616
Mailing Address - Street 1:19070 EVERETT BLVD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 WAUKEGAN RD STE G
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5122
Practice Address - Country:US
Practice Address - Phone:815-227-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty