Provider Demographics
NPI:1679507628
Name:MULTISPECIALTY MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:MULTISPECIALTY MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANDILAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-323-7096
Mailing Address - Street 1:40 S CLAY ST
Mailing Address - Street 2:SUITE 246E
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3257
Mailing Address - Country:US
Mailing Address - Phone:630-323-7096
Mailing Address - Fax:630-323-7531
Practice Address - Street 1:333 CHESTNUT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3247
Practice Address - Country:US
Practice Address - Phone:630-323-7096
Practice Address - Fax:630-323-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-618356261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232680OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL211044Medicare PIN