Provider Demographics
NPI:1710931555
Name:ENDOCRINE CARE LLC
Entity Type:Organization
Organization Name:ENDOCRINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DE BUSTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-532-6490
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4090
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:6703 159TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1781
Practice Address - Country:US
Practice Address - Phone:708-532-6490
Practice Address - Fax:708-532-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081805207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636300OtherBCBSIL GROUP #
IL0001636300OtherBCBSIL GROUP #
IL213789Medicare PIN
ILP00320636Medicare PIN
ILK28653Medicare PIN