Provider Demographics
NPI:1821059452
Name:PHYSICIANS EXPRESS, LLC
Entity Type:Organization
Organization Name:PHYSICIANS EXPRESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-584-9242
Mailing Address - Street 1:2000 W MAIN ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1775
Mailing Address - Country:US
Mailing Address - Phone:630-584-9242
Mailing Address - Fax:630-584-9243
Practice Address - Street 1:2000 W MAIN ST
Practice Address - Street 2:SUITE M
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1775
Practice Address - Country:US
Practice Address - Phone:630-584-9242
Practice Address - Fax:630-584-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214295Medicare ID - Type Unspecified