Provider Demographics
NPI:1750306247
Name:SIGNATURE MEDICAL ASSOCIATES, SC
Entity Type:Organization
Organization Name:SIGNATURE MEDICAL ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-214-5738
Mailing Address - Street 1:7476 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7004
Mailing Address - Country:US
Mailing Address - Phone:847-214-9611
Mailing Address - Fax:847-214-9617
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-214-5738
Practice Address - Fax:547-214-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDB0387OtherMEDICARE PIN - RAIL ROAD MEDICARE
ILDB0387OtherMEDICARE PIN - RAIL ROAD MEDICARE