Provider Demographics
NPI:1740429836
Name:INTERNATIONAL CONSULTING GROUP
Entity Type:Organization
Organization Name:INTERNATIONAL CONSULTING GROUP
Other - Org Name:ICG ASSISTIVE TECHNOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:IWONA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORZENIOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-943-3600
Mailing Address - Street 1:1467 N ELSTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2449
Mailing Address - Country:US
Mailing Address - Phone:312-943-3600
Mailing Address - Fax:312-943-3096
Practice Address - Street 1:1467 N ELSTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2449
Practice Address - Country:US
Practice Address - Phone:312-943-3600
Practice Address - Fax:312-943-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000284332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103034Medicaid
IL1630116OtherBCBS
IL103034Medicaid