Provider Demographics
NPI:1821047457
Name:GERIATRIC CARE SC
Entity Type:Organization
Organization Name:GERIATRIC CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-226-9055
Mailing Address - Street 1:51 SILO RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7372
Mailing Address - Country:US
Mailing Address - Phone:708-226-9055
Mailing Address - Fax:
Practice Address - Street 1:60 ORLAND SQUARE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6548
Practice Address - Country:US
Practice Address - Phone:708-226-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071862207RG0300X
207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634985OtherBC BS
IL036071862Medicaid
IL211968Medicare PIN
IL211057Medicare PIN
ILDD4482Medicare PIN